Unstable Bicondylar Tibial Plateau Fractures: A Clinical Investigation

Eggli, Stefan; Hartel, Maximilian; Kohl, Sandro; Haupt, Uli; Exadaktylos, Aristomenis K.; Röder, Christoph

doi:10.1097/bot.0b013e31818b1452

Cited by 109 publications

(80 citation statements)

References 34 publications

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“…The management of these fractures is challenging, requiring reconstruction of the articular congruity and restoration of the anatomic alignment, rigid fixation of the fragments for early joint motion and weight bearing, and minimal soft-tissue invasion, providing a proper local environment for fracture healing [15][16][17]. The ideal treatment of these fractures is controversial, which depends on the level of fracture comminution, severity of soft tissue injury and bone quality.…”

Section: Introductionmentioning

confidence: 99%

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Chang

Zhang

et al. 2014

International Orthopaedics (SICOT)

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Purpose Bicondylar tibial plateau fractures involving four articular quadrants are severe and complex injuries, and they remain a challenging problem in orthopaedic trauma. The aim of this study was to introduce a new treatment protocol with dual-incision and multi-plate fixation in the floating supine patient position as well as to report the preliminary clinical results. Methods From January 2006 to December 2011, 16 consecutive patients with closed bicondylar four-quadrant tibial plateau fractures (Schatzker type VI, OTA/AO 41C2/3) were treated with posteromedial inverted L-shaped and anterolateral incisions. With the posteromedial approach, three quadrants (posteromedial, anteromedial and posterolateral) can be exposed, reduced and fixed with multiple small antiglide plates and short screws in an enclosure pattern. With the anterolateral approach, after articular elevation and bone substitute grafting, a strong locking plate with long screws to the medial cortex is used to raft-buttress the reduced lateral plateau fracture, hold the entire reconstructed tibial condyles together, and contact the condyles with the tibial shaft. All patients were encouraged to exercise knee motion at an early stage. The outcome was evaluated clinically and radiologically after a minimum two-year follow-up. Results The average operation time was 98±26 minutes (range 70-128) and the average duration of hospitalization was 29±8.6 days (range 20-41). Three cases used five plates, nine cases used four plates, and four cases used three plates. All patients were followed for a mean of 28.7±6.1 months (range 26-38). Fifteen incisions healed initially, while one patient developed a medial wound dehiscence and was successfully managed by debridement. All patients achieved radiological fracture union after an average of 20.2 weeks. At the two-year follow up, the average knee range of motion (ROM) was 98°±13.7 (range 88-125°), with a Hospital for Special Surgery (HSS) knee score of 87.7±10.3 (range 75-95), and SMFA score of 21.3±8.6 (range 12-33). Conclusion For bicondylar four-quadrant tibial plateau fractures, the treatment protocol of multiple medial-posterior small plates combined with a lateral strong locking plate through dual incisions can provide stable fracture fixation to allow for early stage rehabilitation. Good clinical outcomes can be anticipated.

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Section: Introductionmentioning

confidence: 99%

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Chang

Zhang

et al. 2014

International Orthopaedics (SICOT)

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“…The amount of activity patients perform in the first few postoperative weeks can be extremely variable along with the amount of weight bearing. Interestingly in the cases investigated, the non-compliant weight bearing applied by Patient 1 did not lead to excessive displacement of the fracture according to current definitions of anatomical reduction (less than 2 mm of articular step) [5,6] . The results of Patient 1 also suggested that his fracture stabilization was adequate and in these cases weight bearing as tolerated after a TPF may lead to a quicker rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…In the laboratory, articular steps of greater than 1.5 mm of the tibial condyles were shown to cause significantly increased pressure on the surrounding cartilage [4] . In clinical practice, reduction of the articular surface of the tibia with articular steps of less than 2 mm have been labeled as "anatomical" [5,6] , while articular steps of more than 3 mm have been associated with worse outcomes and identified as a risk factor for post-traumatic knee osteoarthritis [2,3] . The problem with correlating outcomes of TPF, and for that matter of any articular fracture, with small articular steps measured on standard radiographs, is that the method is known to have a poor accuracy of ± 5 mm [7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

“…To date, there is no consensus on how TPF patients should be rehabilitated after open reduction and internal fixation (ORIF), with current recommendations varying from non-weight bearing for up to 12 wk [13] to partial weight bearing in all cases [5,6] . It is reasonable to assume that most surgeons would recommend various postoperative weight bearing prescriptions for their patients, depending on the type of fracture and the "quality" of fixation achieved.…”

Section: Introductionmentioning

confidence: 99%

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Collecting a comprehensive evidence base to monitor fracture rehabilitation: A case study

Callary

Thewlis²,

Rowlands³

et al. 2013

WJO

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Author contributions: Solomon LB designed the study and performed the surgery on both patients included in this study; Callary SA performed the radiostereometric analysis radiographic examinations and subsequent measurements; Rowlands AV performed the activity monitoring; Thewlis D performed the gait analysis and subsequent analysis; all authors contributed to detailed analysis, interpretation of results, and the preparation of the manuscript. Abstract AIM: To determine the feasibility and potential role of combining radiostereometric analysis (RSA), gait analysis and activity monitoring in the follow-up of fracture patients. METHODS:Two patients with similar 41B3 tibial plateau fractures were treated by open reduction internal fixation augmented with impaction bone grafting and were instructed to partial weight bear to 10 kg for the first six postoperative weeks. Fracture reduction and fixation were assessed by postoperative computer tomographic (CT) scanning. Both patients had tantalum markers inserted intra-operatively to monitor their fracture stability during healing using RSA and differentially loaded RSA (DLRSA) at 6 and 12 wk postoperatively. Gait analyses were performed at 1, 2, 6, and 12 wk postoperatively. Activity monitors were worn for 4 wk between the 2 and 6 wk appointments. In addition to gait analysis, knee function was assessed using the patient reported Lysholm scores, and doctor reported knee range of motion and stability, at 6 and 12 wk postoperatively. RESULTS:There were no complications. CT demonstrated that both fractures were reduced anatomically. Gait analysis indicated that Patient 1 bore weight to 60% of body weight at 2 wk postoperative and 100% at 6 wk. Patient 2 bore weight at 10% of body weight to 6 wk and had very low joint contact forces to that time. At 12 wk however, there was no difference between the gait patterns in the two patients. Patient 1 increased activities of moderate-vigorous intensity from 20 to 60 min/d between 2 and 6 postoperative weeks, whereas Patient 2 remained more stable at 20-30 min/d. The Lysholm scores were similar for both patients and did not improve between 6 and 12 wk postoperatively. DLRSA examination at 12 wk showed that both patients were comfortable to weight bear to 80 kg and under this weight the fractures displaced less than 0.4 mm. RSA measurements demonstrated over time fracture migrations of less than 2 mm in both cases. However, Patient 2, who followed the postoperative weight bearing instructions most closely, displaced less (0.3 mm vs 1.6 mm). CONCLUSION:This study demonstrates the potential of using a combination of RSA, gait analysis and activity monitoring to obtain a comprehensive evidence base for postoperative weight bearing schedules during fracture healing.

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“…In Cong-fengluo et al series average range of the affected knee was 2.7º to 123.4º. 24 In Eggli et al 7% patients had developed DVT and Barei et al series there was 2% patients had DVT. 24,26 No patient in our series had developed decubitus ulcer.…”

Section: Discussionmentioning

confidence: 99%

Plating as an operative management of intra articular fractures of the upper end of tibia: a prospective clinical study

et al. 2017

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Background: Tibial plateau fracture management is challenging because of the severe displacement of the bony fragments, the concomitant depression and impaction of the cancellous subchondral bone, and the inevitable associated cartilage injury.Methods: A prospective cohort study of 25 patients who suffered high energy intra-articular fractures of proximal tibia was done and they were diagnosed and classified according to Schatzker’s classification. The study was done to study the outcomes of surgical management of high energy tibial plateau fractures with buttress plate, to achieve anatomical reduction and absolute stable internal fixation to prevent malunion, to achieve early mobilisation, to prevent post-operative knee stiffness and also to determine timing of operation after trauma and sequence of fixation of bicondylar fractures. All patients were treated with open reduction and internal fixation with a buttress plate either a lateral, medial or bicondylar plating.Results: Average radio-graphic bony union time was 12 weeks. Average full weight bearing time was 13 weeks. Knee stiffness improved with physiotherapy and full range was achieved on an average in 8 weeks, mean range of movement 0-124.5º was achieved. 4 patients (16%) developed infection. Conclusions: Fractures of upper end of tibia can be treated with the plating technique, to achieve anatomical reduction and stable internal fixation with 82% good functional outcome. The plating technique facilitates early mobilisation of injured joint and attains good range of movements. Minimal mal reduction does not seem to vitiate the results. The infection rate of 16% is of concern with this procedure, but responds well to antibiotics and surgical debridement.

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Unstable Bicondylar Tibial Plateau Fractures: A Clinical Investigation

Cited by 109 publications

References 34 publications

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Collecting a comprehensive evidence base to monitor fracture rehabilitation: A case study

Plating as an operative management of intra articular fractures of the upper end of tibia: a prospective clinical study

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