Abstract
Background: Treatment of Split and depressed fracture of proximal tibial plateu has undergone substantial evaluation in recent years from conventional butreessing plates to angled fixed locking plates. This study was performed in adults to determine the efficacy of open reduction, elevation, lateral knee arthrotomy, Iliac Tricortical Strut bone grafting and raft locking fixation in comparision to Conventional buttressing T or L plates for intraarticular lateral condyle fractures of tibia ie Schatzer type II or AO Ota 4.1 B3 on union, implant failure and incidence of malalignment, collapse and loss of reduction in patients who sustained an intra-articular fracture of the proximal tibia
Methods: We reviewed the records of 36 proximal tibia that involving split and depression type of lateral tibial condyle fracture Between april 2008 and December 2016. Schatzer type II or AO Ota 4.1B3 fractures in adults having step more than 5 mm and increase in valgus more than 10 degrees were included for study. Group A has undergone low profile raft locked fixation using standard technique whereas Group B by conventional T or L Butrss Plates or Hockey plates. The Radilogical anlalysis was done till follow-up of two year
Results: primary union was still evident in 97.32%. no incidence of broken plate, infection or collapse no revision surgery. delayed union especially in osteoporotic bones and non locking groupLate Collapses are seen in Group B. 4 Pts had excellent results, 2 had good results and 4 had fair results.
Conclusions: The raft locked fixation with tricortical bone grafts is matching the gold standard method of treatment in our institute for treatment of proximal metaphyseal lateral tibial tibial plateu fractures especially in osteoporotic bones.
Key Words- Schatzer II fractures, Locking plates, Non locking plates, Tricorticl strut grafts.
References
- Ali AM, Yang L, Hashmi M, Saleh M. Bicondylar tibial plateau fractures managed with the Sheffield Hybrid Fixator. Biomechanical study and operative technique. Injury 2001;32(Suppl 4):SD86–91.
- Bennett WF, Browner B. Tibial plateau fractures: a study of associated soft tissue injuries. J Orthop Trauma 1994;8:183–8.
- Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res 1979;138:94–104.
- Ong JC, Kennedy MT, Mitra A, Harty JA. Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study. Ir J Med Sci 2012;181:247–52.
- Goulet JA, Senunas LE, DeSilva GL, Greenfield ML. Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop Relat Res 1997;339:76–81.
- Iundusi R, Gasbarra E, D’Arienzo M, Piccioli A, Tarantino U. Augmentation of tibial plateau fractures with an injectable bone substitute: CERAMENTTM. Three year follow-up from a prospective study. BMC Musculoskelet Disord 2015;16:115.
- Whittle AP, Wood GW. Fractures of lower extremity. In: Canale ST, editor. Camp-bell’s operative orthopaedics. Vol. 3, 10th
- Philadelphia: Mosby; 2003:2725–872.
- Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 1973;55:1331–50.
- Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985;198:43–9.
- Honkonen SE. Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 1995;9:273–7.
- Hohl M, Luck JV. Fractures of the tibial condyle; a clinical and experimental study. J Bone Joint Surg Am 1956;38:1001–18.
- Hohl M. Tibial condylar fractures. J Bone Joint Surg Am 1967;49:1455–67.
- Stannard JP, Wilson TC, Volgas DA, Alonso JE. The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma 2004;18:552–8.
- Watson JT, Coufal C. Treatment of complex lateral plateau fractures using Ilizarov techniques. Clin Orthop Relat Res 1998;353:97–106.
- Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002;84:1541–51.
- Singh S, Patel PR, Joshi AK, Naik RN, Nagaraj C, Kumar S. Biological approach to treatment of intra-articular proximal tibial fractures with double osteosynthesis. Int Orthop 2009;33:271–4.
- Yu Z, Zheng L, Zhang Y, Li J, Ma B. Functional and radiological evaluations of high-energy tibial plateau fractures treated with double-buttress plate fixation. Eur J Med Res 2009;14:200–5.
- Catinella FP, De Laria GA, De Wald RL. False aneurysm of the superior gluteal artery. A complication of iliac crest bone grafting. Spine (Phila Pa 1976) 1990;15:1360–2.
- Cohn BT, Krackow KA. Fracture of the iliac crest following bone grafting. A case report. Orthopedics 1988;11:473–4.
- Guha SC, Poole MD. Stress fracture of the iliac bone with subfascial femoral neuropathy: unusual complications at a bone graft donor site: case report. Br J Plast Surg 1983;36:305–6.
- Kurz LT, Garfin SR, Booth RE Jr. Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine (Phila Pa 1976) 1989;14:1324–31.
- Palmer SH, Gibbons CL, Athanasou NA. The pathology of bone allograft. J Bone Joint Surg Br 1999;81:333–5.
- Segur JM, Torner P, García S, Combalía A, Suso S, Ramón R. Use of bone allograft in tibial plateau fractures. Arch Orthop Trauma Surg 1998;117:357–9.
- Sugihara S, van Ginkel AD, Jiya TU, van Royen BJ, van Diest PJ, Wuisman PI. Histopathology of retrieved allografts of the femoral head. J Bone Joint Surg Br 1999;81:336–41.
- Welch RD, Zhang H, Bronson DG. Experimental tibial plateau fractures augmented with calcium phosphate cement or autologous bone graft. J Bone Joint Surg Am 2003;85:222–31.
- Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, Benirschke SK. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am 2006;88:1713–21.
- Wu CC. Salvage of proximal tibial malunion or nonunion with the use of angled blade plate. Arch Orthop Trauma Surg 2006;126:82–7.
- Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, et al. Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am 2002;84:1259–71.
- Duwelius PJ, Rangitsch MR, Colville MR, Woll TS. Treatment of tibial plateau fractures by limited internal fixation. Clin Orthop Relat Res 1997;339:47–57.
- Westmoreland GL, McLaurin TM, Hutton WC. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. J Orthop Trauma 2002;16:178–81.
- Benirschke SK, Swiontkowski MF. Knee. In: Hansen S, Swiontkowski MF, editors. Orthopaedic trauma protocols. 1st ed. New York: Raven Press; 1993:313–325.
- Koval KJ, Sanders R, Borrelli J, Helfet D, DiPasquale T, Mast JW. Indirect reduction and percutaneous screw fixation of displaced tibial plateau fractures. J Orthop Trauma 1992;6:340–6.
- Denny LD, Keating EM, Engelhardt JA, Saha S. A comparison of fixation techniques in tibial plateau fractures. Orthop Trans 1984;10:388–9.
- Karunakar MA, Egol KA, Peindl R, Harrow ME, Bosse MJ, Kellam JF. Split depression tibial plateau fractures: a biomechanical study. J Orthop Trauma 2002;16:172–7.
- Cross WW 3rd, Levy BA, Morgan JA, Armitage BM, Cole PA. Periarticular raft constructs and fracture stability in splitdepression tibial plateau fractures. Injury 2013;44:796–801.
Corresponding Author
Dr Neetin Pralhad Mahajan
Associate Professor, (Orthopaedics)
Flat No. 12, Panchsheel Building, Sir J J Hospital Compound, Bycuula, Mumbai 400008
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.