tibial plateau fractures Obada B Serban AlO Botnaru V Alecu SilvanaCrina Orthopaedic Traumatology Clinic of Constanta Romania Objective The study aim to establish some clear principles of therapeutic approach so as the current therapeutic moment not to beco ID: 655457
Download Presentation The PPT/PDF document "Surgical principles of treatment for" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Surgical principles of treatment for tibial plateau fractures
Obada B., Serban Al.O., Botnaru V., Alecu Silvana-CrinaOrthopaedic-Traumatology Clinic of Constanta, Romania
ObjectiveThe study aim to establish some clear principles of therapeutic approach, so as the current therapeutic moment not to become a simple stage to a future knee arthroplasty.
Material. Methods.64 tibial plateau fractures were studied from Jan 2012 to Dec 2013 and followed-up for minimum period of 6 months. The systematisation of the casuitry was made using Schatzker and AO classifications. Arthrosis risk was evaluated using Kellgren/Lawrence score. Functional evaluation of the knee was made using Lysholm score.
Results. Discussions.
Demographic profile CriteriaNoMean age (years)46 (20-67)Mean follow-up (month)11Sex (male/female)39/25Low /high energy trauma19/45Falling from height34Car accident21Other etiologies9Type 41B36Type 41C28
Mandatory imagistic investigations for preoperative planning
Xray
, CT, CT3D, MRITreatment objectivesanathomic reconstructionstable fixationvascularity preservationearly mobilisation
Important aspects to considerDepression – submeniscal approach, checked in frontal and sagital view Correct width of the plateau after reduction – anathomic relation with condyles, butress effect of the plateMetaphiseal fixation – one plate for each columne (medial and lateral)Subchondral deffect – bone graftSoft tissue monitorisation (Schatzker V,VI and AO 41C)Crucial question – When is the optimal surgical moment?Delay period of time was between 7-12 days.Damage controlProvisional external fixation ensure:bone and soft tissue stabilitycontrol length, axis, rotationindirect reduction through ligamentotaxisIndications for ExFix:unstable fracturesrisk of compartmental syndromesoft tissue lessionsSurgical approachesanterolateral, posteromedial, posterior
Osteosynthesis methodsProvisional ExFix6CRIFCannulated screws8ORIF1 platenonblocking16blocking132 platesnonblocking111 nonblocking + 1 blocking10blocking6Bone graft14
Radiologic evaluation of arthrosis at 1 year after surgery
MRI at 1 year after surgeryLateral meniscus lesions53%Medial meniscus lesions 19%ACL lesions21%
Functional evaluation of knee at 1 year after surgery
Conclusions
A correct surgical
management of
tibial
plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early
motion,
reduce arthrosis risk and hence to achieve optimal knee function. The choice of optimal surgical methods, proper approach and implant is made personalised in relation to fracture type according Schatzker and AO classification. There is no significant difference reagarding arthrosis risk for the type B and C fractures. Arthrosis is generally well tolerated.
Fracture 41-B1,
Schatzker
IV,
postero
-internal fragment. Locking plate
osteosynthesis
.
41-C2,
Schatzker
V, 2 locking plates. 6 months after surgery. Full weight bearing.
41-C3,
Schatzker
V. 2 locking plates. 3, 6 months after surgery.
Algodistrophy
41-C2,
Schatzker
V –postoperative and at 6 months.
41-C3,
Schatzker
VI.
ExFix
, locking plate.
41-C2,
Schatzker
VI.
ExFix
, locking plate.
41-C3,
Schatzker
VI. 1 locking and 1
nonlocking
plates. 6,
9
months after surgery.
41-B3,
Schatzker
II. Locking plate and bone graft after 1 year.
41-C2,
Schatzker
V – 2
nonlocking
plates at 1 year.
41-B3,
Schatzker
II.
Nonlocking
plate, bone graft. Aspects at 1 year.
41-C2,
Schatzker
V
– 1 locking and 1
nonlocking
plates at 1 year.