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Category: Volume 08 Issue 02 February 2020
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Title: Arthroscopic Assisted Internal Fixation (AAIF) of Tibial Plateau Fractures; A Novel Technique

Authors: Ansarul Haq Lone, Dar Ghulam Nabi, Mohammad Mussa

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.106

Abstract

   

Introduction: The difficulty in achieving precise reduction using conservative methods and the higher morbidity associated with traditional surgical methods have led to the development of semi invasive techniques. The treatment of tibial plateau fractures with AAIF is one method that is associated with lower morbidity, less extensive surgical dissection. Furthermore, arthroscopy allows the surgeon to diagnose and treat concomitant intra-articular injuries.

Methods and Materials: This study consisted of 25 patients with closed fractures of tibial plateau in adults of both sexes and was conducted in the post-graduate department of orthopaedics Bone and Joint Surgery Hospital, Government Medical College Srinagar from September 2011 to October 201. After thorough pre-operative work-up AAIF was done in all 25 patients and in some patients bone grafting was done elevating the depressed articular fragment in these cases fixation was done using 2 or 3 hole proximal tibial locking compression plates.

Observations and Results: In our study 14 patients had type II (split depression of lateral condyle) tibial plateau fractures, 7 patients had type I fractures. 2 patients each with Type III and type IV tibial plateau fractures. Most common type of intra-articular injuries in our study was meniscal injuries comprising of 40% of all cases. Lateral meniscal injuries were more common than medial meniscal injuries, because lateral condyle fractures were more than medial condyle fractures.

Discussion: Review of the literature suggests AAIF to be equal to or better than open reduction internal fixation (ORIF) in achieving anatomical reduction. In the study of H. Kiefer et al (2001) of a series of 31 fractures, 25 showed anatomical reduction at a mean of 25 months. F. Van Glabbeek and van Riet (2002) were unable to arthroscopically reduce only 1 of 20 split/depression fractures.

Conclusion: AAIF is a novel technique in the treatment of properly selected cases of tibial plateau fractures because of diagnosis and treatment of associated intra-articular soft tissue injuries and visualization of chondral surface reduction.

Keywords: Arthroscopy, Tibial Plateau, Soft-tissue injuries.

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Corresponding Author

Ansarul Haq Lone

MS Orthopaedics, Lecturer Postgraduate Department of Orthopedics GMC Srinagar