Weight-bearing-induced displacement and migration over time of fracture fragments following split depression fractures of the lateral tibial plateau

Solomon, Lucian B.; Callary, Stuart A.; Stevenson, Aaron W.; McGee, Margaret A.; Chehade, Mellick; Howie, Donald W.

doi:10.1302/0301-620x.93b6.26122

Cited by 44 publications

(39 citation statements)

References 21 publications

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“…All patients had tantalum beads inserted at the time of surgery [19,30,31] to enable RSA to be used to measure fracture migration accurately during healing. Clusters of at least 4 beads were inserted in the reduced articular fragment and the un-fractured tibial metaphysis as previously described [30,32,33].…”

Section: Imagingmentioning

confidence: 99%

Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures: Early results of a case series

Pol

Iselin

Callary

et al. 2015

Injury

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Section: Imagingmentioning

confidence: 99%

Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures: Early results of a case series

Pol

Iselin

Callary

et al. 2015

Injury

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“…However, during the DLRSA examinations performed under weight-bearing as tolerated at two and six postoperative weeks, two out of seven patients exceeded 20 kg at 2 wk and three were full weight bearing at 6 wk. Despite all fracture movements under load being reported to be elastic (the final position of the fracture returned to the preload position), the fractures were found to have migrated over time up to 2 mm in the cranio-caudal and medio-lateral directions [17] . These results suggest that during the first six postoperative weeks, the patients either loaded more than their body weight through their injured knee and/or the direction of the joint reaction forces during ambulation differed from that during standing for the DLRSA examinations.…”

Section: Introductionmentioning

confidence: 93%

“…DLRSA examinations were performed at 6 and 12 wk with each patient standing on a custom built platform that allows centering of the patient's knee in front of the RSA calibration cage, as described previously [17] . During the RSA examination, a digital foot scale was used to measure the load applied whilst weight bearing.…”

Section: Patient Activity Monitoringmentioning

confidence: 99%

“…To our knowledge, we have performed the only study to investigate the stability of TPF in patients allowed to weight bear in the first six postoperative weeks [17] . We used RSA and differentially loaded RSA (DLRSA) performed under weight bearing load to assess fracture fragment stability [17] .…”

Section: Introductionmentioning

confidence: 99%

“…We used RSA and differentially loaded RSA (DLRSA) performed under weight bearing load to assess fracture fragment stability [17] . Patients were recommended a postoperative partial weight-bearing regimen of 20 kg for the first six postoperative weeks, followed by progressive weight bearing as tolerated.…”

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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Peak loading during walking is not associated with fracture migration following tibial plateau fracture: A preliminary case series

Thewlis

Callary

Fraysse

et al. 2015

Journal Orthopaedic Research

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Tibial plateau fractures are common, but little evidence exists for their postoperative management, especially when recommending if patients should weight bear at all, partially, or as tolerated. In this study, we describe the loads passing through the fracture construct and the associated fracture migration over the first year following surgery. Nine patients were treated with open reduction and internal fixation and instructed to weight bear as tolerated. Fracture loading and migration were assessed at 2, 12, 26, and 52 weeks postoperative. Fracture loading was calculated as the knee joint reaction force (peak, average, the angle of the force vector, and the point of force application) using gait analysis and an inverse dynamics musculoskeletal model. Fracture migration was assessed using radiostereometric analysis. The fractures were progressively loaded during the rehabilitation phase. The point of application of the load shifted from neutral to medial by week 26 for all patients. Migration during the first postoperative year was within current clinical acceptable limits. The peak load during walking at each time point was not associated with fracture fragment migration and does not appear to exceed the elastic limit of the fracture construct. ß

show abstract

Weight-bearing-induced displacement and migration over time of fracture fragments following split depression fractures of the lateral tibial plateau

Cited by 44 publications

References 21 publications

Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures: Early results of a case series

Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures: Early results of a case series

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

Peak loading during walking is not associated with fracture migration following tibial plateau fracture: A preliminary case series

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