Tibial plateau fracture management: arthroscopically-assisted versus ORIF procedure – clinical and radiological comparison

Elabjer, Esmat; Benčić, Ivan; Ćuti, Tomislav; Cerovečki, Tomislav; Ćurić, Stjepan; Vidović, Dinko

doi:10.1016/s0020-1383(17)30742-8

Cited by 30 publications

(37 citation statements)

References 25 publications

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“…Contrary to our study, Elabjer et al. 29 examined 78 patients with lateral unicondylar fractures (Schatzker I-III) and found no difference in rates of postoperative infection. Regardless, there have been no reports that suggest that the addition of knee arthroscopy to tibial plateau fracture fixation increases the rate of infection.…”

Section: Discussioncontrasting

confidence: 99%

Trends and Complications of Arthroscopic-Assisted Tibial Plateau Fracture Fixation: A Matched Cohort Analysis

Shamrock

Khazi

Gulbrandsen

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To determine trends in arthroscopic-assisted tibial plateau fracture fixation (AATPFF), to evaluate trends in the overall rate of tibial plateau fracture fixation, and to compare postoperative complications between AATPFF and traditional tibial plateau fixation. Methods A retrospective review of patients undergoing AATPFF and traditional tibial plateau fixation was conducted using the Humana Inc. administrative database from 2007 to 2016. A 1:1 propensity match was utilized to match patients in the 2 study groups based on age, sex, obesity, diabetes, hypertension, chronic obstructive pulmonary disease, depression or anxiety, and smoking history. Postoperative complications were grouped as minor medical complications, major medical complications, surgical complications, emergency department visits, and reoperation. Linear regression analysis was used to assess trends and Pearson’s χ 2 test was used to compare postoperative complications with statistical significance defined as P < .05. Results In total, 522 patients underwent AATPFF and 3920 patients underwent traditional tibial plateau fracture fixation. There was a 4-fold increase in the use of AATPFF over the study period ( P = .0173). Similarly, there was an increase in the utilization of traditional tibial plateau fracture fixation, although to a lesser extent (1.33-fold). After propensity matching, the traditional fixation group demonstrated significantly higher rates of minor medical complications (8.2% vs 2.7%, P = .0002), major medical complications (9.9% vs 4.6%, P = .0018), surgical complications (13.2% vs 2.7%, P < .0001), and emergency department visits (21.4% vs 13.5%, P < .0001) within 90 days of surgery compared with the AATPFF group. There was no difference in reoperation rates within 90 days between the 2 groups (2.9% vs 3.6%, P = .85). Conclusions The incidence of tibial plateau fracture fixation is increasing, however, use of AATPFF is increasing at a faster rate compared to traditional techniques. Furthermore, the addition of knee arthroscopy to fracture fixation does not increase the risk of complication, reoperation, or emergency department visit within 90 days. Level of Evidence III, retrospective matched cohort.

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Section: Discussioncontrasting

confidence: 99%

Trends and Complications of Arthroscopic-Assisted Tibial Plateau Fracture Fixation: A Matched Cohort Analysis

Shamrock

Khazi

Gulbrandsen

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Tibial plateau fractures are articular injuries which have a broad spectrum of clinical presentations and are frequently associated with long term complications [1,2]. In recent years these challenging fractures have become a topic of great interest not only regarding their classification but also fixation methods and expected outcomes [3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Revisiting the Schatzker classification of tibial plateau fractures

Kfuri

Schatzker

2018

Injury

174

143

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A B S T R A C TTibial plateau fractures have a broad spectrum of presentations, depending on the mechanism and energy of the trauma. Many classification systems are currently available to describe these injuries. In 1974, Schatzker proposed a classification based on a two-dimensional representation of the fracture. His classification with the six-principles types became one of the most utilized classification systems for tibial plateau fractures. More than four decades after this original publication, we are revisiting each fracture type in the light of information made available by computed tomography, which today comprises a standard tool in assessing articular fractures. The classification we are proposing relies on the fact that the tibial plateau has two anatomical columns, lateral and medial. We are introducing a virtual equator which splits the articular surface in the coronal plane. The equator divides each column into two quadrants, the anterior (A) and the posterior (P). Unicondylar fracture types (I to IV) have now additional modifiers A (anterior) and P (posterior) to describe the exact spatial location of the primary fracture plane. Bicondylar fracture types (V and VI) have the modifiers (A and P) of the main fracture plane for each column, and lateral (L) and medial (M) to denote the column. We are introducing the concept of the main fracture plane. Recognition of the exact location of the principal fracture plane is essential for preoperative planning of patient positioning, surgical approach and for determining where to apply the hardware to achieve stable fixation. The new three-dimensional classification is based on the template of the original Schatzker classification. It covers the mechanism of the injury, the energy of the trauma, the morphologic characteristics of the fracture and its location in three dimensions.

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“…Recently, fracturoscopy has been used in TPF to help improve intraoperative fracture reduction [4][5][6][7]. Furthermore, different approaches for fracturoscopy have been reported.…”

Section: Introductionmentioning

confidence: 99%

Effect of fracturoscopy on the incidence of surgical site infections post tibial plateau fracture surgery

Henkelmann¹,

Krause

Alm³

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Surgical treatment of tibial plateau fracture (TPF) is common. Surgical site infections (SSI) are among the most serious complications of TPF. This multicentre study aimed to evaluate the effect of fracturoscopy on the incidence of surgical site infections in patients with TPF. Methods We performed a retrospective multicentre study. All patients with an AO/OTA 41 B and C TPF from January 2005 to December 2014 were included. Patients were divided into three groups: those who underwent arthroscopic reduction and internal fixation (ARIF), and those who underwent open reduction and internal fixation (ORIF) with fracturoscopy, and those treated with ORIF without fracturoscopy. The groups were compared to assess the effect of fracturoscopy. We characterised our cohort and the subgroups using descriptive statistics. Furthermore, we fitted a logistic regression model which was reduced and simplified by a selection procedure (both directions) using the Akaike information criterion (AIC). From the final model, odds ratios and inclusive 95% confidence intervals were calculated. Results Overall, 52 patients who underwent fracturoscopy, 48 patients who underwent ARIF, and 2000 patients treated with ORIF were identified. The rate of SSI was 0% (0/48) in the ARIF group and 1.9% (1/52) in the fracturoscopy group compared to 4.7% (93/2000) in the ORIF group (OR = 0.40, p = 0.37). Regression analyses indicated a potential positive effect of fracturoscopy (OR, 0.65; 95% CI, 0.07–5.68; p = 0.69). Conclusion Our study shows that fracturoscopy is associated with reduced rates of SSI. Further studies with larger cohorts are needed to investigate this. Level of evidence Level III.

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Tibial plateau fracture management: arthroscopically-assisted versus ORIF procedure – clinical and radiological comparison

Cited by 30 publications

References 25 publications

Trends and Complications of Arthroscopic-Assisted Tibial Plateau Fracture Fixation: A Matched Cohort Analysis

Trends and Complications of Arthroscopic-Assisted Tibial Plateau Fracture Fixation: A Matched Cohort Analysis

Revisiting the Schatzker classification of tibial plateau fractures

Effect of fracturoscopy on the incidence of surgical site infections post tibial plateau fracture surgery

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