Abstract
Purpose
This study was to evaluate clinical outcomes and complications following multi-plate reconstruction for treating severe bicondylar tibial plateau fractures of young adults.
Methods
Between September 2007 and February 2012, 26 patients with severe bicondylar tibial plateau fractures met inclusion criteria; they were treated using multi-plate technique through combined approaches. Patients received an average follow-up of 40.8 (range, 18–64) months, which included anteroposterior and lateral imaging, postoperative complications, range of motion and stability of the knee. The Rasmussen score was applied for functional and radiological evaluation.
Results
Three to five plates were used for reconstruction. No intra-operative complications occurred. Postoperative complications included bulge of hardware in four patients and superficial dehiscence in three cases in the anterolateral incision of which one developed to deep infection. There was no neurovascular damage, and no implant breakage or loosening. Hardware was removed partly or totally in 16 cases. The average Rasmussen score at final follow-up was 27.2 (range, 21–30) points for functional evaluation and 16.4 (range, 14–18) for radiology.
Conclusions
Multi-plate reconstruction is a valid and safe method for treating severe bicondylar tibial plateau fractures of young adults.
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References
Eggli S, Hartel MJ, Kohl S, Haupt U, Exadaktylos AK, Röder C (2008) Unstable bicondylar tibial plateau fractures: a clinical investigation. J Orthop Trauma 22(10):673–679. doi:10.1097/BOT.0b013e31818b1452
Canadian Orthopaedic Trauma Society (2006) Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am 88(12):2613–2623
Kini SG, Sathappan SS (2013) Role of navigated total knee arthroplasty for acute tibial fractures in the elderly. Arch Orthop Trauma Surg 133(8):1149–1154. doi:10.1007/s00402-013-1792-8
Biggi F, Di Fabio S, D’Antimo C, Trevisani S (2010) Tibial plateau fractures: internal fixation with locking plates and the MIPO technique. Injury 41(11):1178–1182. doi:10.1016/j.injury.2010.08.001
Weil YA, Gardner MJ, Boraiah S, Helfet DL, Lorich DG (2008) Posteromedial supine approach for reduction and fixation of medial and bicondylar tibial plateau fractures. J Orthop Trauma 22(5):357–362. doi:10.1097/BOT.0b013e318168c72e
Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, Benirschke SK (2006) Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am 88(8):1713–1721
Luo CF, Sun H, Zhang B, Zeng BF (2010) Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 24(11):683–692. doi:10.1097/BOT.0b013e3181d436f3
Nikolaou VS, Tan HB, Haidukewych G, Kanakaris N, Giannoudis PV (2011) Proximal tibial fractures: early experience using polyaxial locking-plate technology. Int Orthop 35(8):1215–1221. doi:10.1007/s00264-010-1153-y
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L (2007) Fracture and dislocation classification compendium 2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133
Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture: the Toronto experience 1968–1975. Clin Orthop Relat Res 138:94–104
Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742–746
Tscherne H, Oestern HJ (1982) A new classification of soft-tissue damage in open and closed fractures. Unfallheilkunde 85:111–115
Chang SM, Wang X, Zhou JQ, Huang YG, Zhu XZ (2012) Posterior coronal plating of bicondylar tibial plateau fractures through posteromedial and anterolateral approaches in a healthy floating supine position. Orthopedics 35(7):583–588. doi:10.3928/01477447-20120621-03
He X, Ye P, Hu Y, Huang L, Zhang F, Liu G, Ruan Y, Luo C (2013) A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures. Arch Orthop Trauma Surg 133(1):23–28. doi:10.1007/s00402-012-1632-2
Rasmussen PS (1973) Tibial condylar fractures: impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 55:1331–1350
Prasad GT, Kumar TS, Kumar RK, Murthy GK, Sundaram N (2013) Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates. Indian J Orthop 47(2):188–194. doi:10.4103/0019-5413.108915
Weaver MJ, Harris MB, Strom AC, Smith RM, Lhowe D, Zurakowski D, Vrahas MS (2012) Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures. Injury 43(6):864–869. doi:10.1016/j.injury.2011.10.035
Barei DP, O’Mara TJ, Taitsman LA, Dunbar RP, Nork SE (2008) Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma 22(3):176–182. doi:10.1097/BOT.0b013e318169ef08
Weigel DP, Marsh JL (2002) High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 84-A:1541–1551
Honkonen SE (1994) Indications for surgical treatment of tibial condyle fractures. Clin Orthop 302:199–205
Sun H, Luo CF, Yang G, Shi HP, Zeng BF (2013) Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol 23(7):809–818. doi:10.1007/s00590-012-1067-z
Heidari N, Lidder S, Grechenig W, Tesch NP, Weinberg AM (2013) The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau: a cadaver study. J Orthop Trauma 27(4):221–225. doi:10.1097/BOT.0b013e318271f8f0
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Zhai, Q., Hu, C. & Luo, C. Multi-plate reconstruction for severe bicondylar tibial plateau fractures of young adults. International Orthopaedics (SICOT) 38, 1031–1035 (2014). https://doi.org/10.1007/s00264-013-2211-z
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DOI: https://doi.org/10.1007/s00264-013-2211-z