Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment

Abstract

ObjectiveThe aim of this study was to evaluate our treatment algorithm and results in revision surgery of malunited tibial plateau fracture after failure of initial treatment.MethodsOur revision strategy was as follows: First, we determined the presence of any infection. Second, we determined whether the patient required total knee arthroplasty (TKA). Third, based on the characteristics of the tibial plateau fracture malunion, patients underwent one of the following surgical methods to achieve reduction: original fracture line osteotomy, tibial tubercle + original fracture line osteotomy, fibula head + original fracture line osteotomy, and metaphyseal open window reduction rod technique. The results was assessed with healing time, Rasmussen score, knee range of motion and complication rates.ResultsA total of 25 patients 16 men and 9 women; Mean age: 47.4 years (range: 35–63 years) underwent tibial plateau fracture revision operation. The time interval between the two surgeries was 2–24 months. The follow-up time was 12–30 months, and the operation time was 120–300 min. All patients received bone union at the last follow-up. The healing time was 3–6 months. The postoperative Rasmussen score was 19–29 (mean 23.8) compared with 14.4 points before the operation (p < 0.05). The postoperative knee joint activity was 60–110° (mean 95.0°), compared with 57.8° before the operation (p < 0.05). Six patients still had a 2-mm collapse on the articular surface, and 4 patients still had slight valgus (<5°). Except for 2 TKA cases, fracture reduction was excellent in 15 cases and good in 8 cases, with a good rate of 100%. Superficial wound infections occurred in 3 patients.ConclusionBecause revision of tibial plateau fracture malunion caused by failure of initial treatment is difficult, it is necessary to create a detailed surgical plan before the operation. Satisfactory clinical effects can be obtained if the correct revision strategy is used. The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion.Level of EvidenceLevel IV, Therapeutic Study.

Intraarticular osteotomy of malunited tibial plateau fractures: an analysis of clinical results with a mean follow-up after 4 years

“…They showed that a correction of the intraarticular depression and valgus malalignment provides good results and that the anatomic leg axis was restored in all patients. In line with Krettek et al and Liangjun et al, we believe that a malunited TPF is better treated with intraarticular osteotomy to gain an anatomical articular surface and alignment restoration [ 5 , 20 ]. Liangjun et al analysed 25 patients with malunited TPF while in 15 cases an intraarticular osteotomy was performed and satisfactory patient outcomes were achieved [ 5 ].…”

“…In line with Krettek et al and Liangjun et al, we believe that a malunited TPF is better treated with intraarticular osteotomy to gain an anatomical articular surface and alignment restoration [ 5 , 20 ]. Liangjun et al analysed 25 patients with malunited TPF while in 15 cases an intraarticular osteotomy was performed and satisfactory patient outcomes were achieved [ 5 ]. Wang et al demonstrated 13 patients with posterolateral tibial plateau fracture malunion and intraarticular osteotomy at a mean follow-up of 20 months [ 6 ].…”

“…Limited range of motion, infection of the knee and malunion lead to impaired patient outcome after primary osteosynthesis [ 3 , 4 ]. Malunion after primary osteosynthesis of the TPF often results in dysfunction of the knee as it can lead to chronic subluxation, pseudo-instability, stiffness and posttraumatic osteoarthritis [ 5 , 6 ]. There are only a few treatment options, including the intraarticular osteotomy in order to improve malunion of the TPF [ 7 , 8 ].…”

“…There are only a few treatment options, including the intraarticular osteotomy in order to improve malunion of the TPF [ 7 , 8 ]. While intraarticular osteotomy of the malunited TPF is technical demanding, there is little evidence about the clinical outcome after surgical revision [ 5 , 6 ].…”

Are all Schatzker Type-II tibial plateau fractures alike? A retrospective study

“…In current practice, routine use of the computer tomography (CT) scan led to the development of multiple CT-based classi cations, which has made it possible to identify the coronal plane fracture and localize the fracture with respect to the quadrants [2,3]. Yet, it is not very infrequent to encounter signi cant malunion after surgical management of split and depression lateral tibial plateau fracture, which mandates revision surgery or conversion to the arthroplasty [4,5]. Meulenkemp et al [6] also reported that the lateral tibial plateau is the commonest area to encounter malunion and incidence may range 23 to 77%.…”