2015, Number 2
<< Back Next >>
Acta Ortop Mex 2015; 29 (2)
Posteromedial approach and plating for a tibial plateau fracture with a posterior fragment
Robledo-Herrera O, Diego-Ball D, Oliva-Ramírez S
Language: Spanish
References: 23
Page: 69-76
PDF size: 283.71 Kb.
ABSTRACT
Background: Tibial plateau fractures account for 1% of all fractures. Ten percent of them involve the medial plateau. The spectrum of lesions ranges from undisplaced fractures to devastating fractures involving the entire tibial plateau, which warrant extensive surgical management. The orthopedic surgery literature suggests that positive functional and radiographic results depend on the type of approach, the quality of reduction and the type of implant used.
Material and methods: Ambispective case report: seven patients were enrolled, with fracture of the medial tibial plateau and a posterior fragment. A posterior plate was placed after a posteromedial approach, between August 2012 and August 2013. Fractures were staged according to the Khan classification. Functional and radiographic results were assessed using the Rasmussen scale. Frequency and descriptive statistics were used.
Results: Pain was measured using a visual analog scale (VAS), with scores ranging from two to four. Flexion ranged between 40o and 110o, with a minimum extension deficit of 15o and a maximum of 40o. Four subjects had varus deformity, three had valgus deformity.
Conclusions: The posteromedial approach and placement of a posterior plate for tibial plateau fractures results in ranges of motion that permit an appropriate function and involve mild pain. Varus angulation occurs in patients with bilateral tibial plateau fractures.
REFERENCES
Purnell M: Diagnosis and surgical treatment of Schatzker type IV variant biplanar medial tibial plateau fractures in alpine skiers. Techniques in Knee Surgery. 2007; 6(1): 17-28.
Rüedi TP, Murphy WM: Principios de la AO en el tratamiento de las fracturas. México: Ed. Masson; 2003.
Schatzker J: The rationale of operative fracture care. 3rd ed. Berlin Heidelberg: Springer-Verlag; 2005.
Berkson EM, Virkus WW: High-energy tibial plateau fractures. J Am Acad Orthop Surg. 2006; 14(1): 20-31.
Koval KJ, Helfet DL: Tibial plateau fractures: evaluation and treatment. J Am Acad Orthop Surg. 1995; 3(2): 86-94.
Lugones A: Abordaje posteromedial para la reducción y estabilización del componente posteromedial en fracturas del platillo tibial. Rev Asoc Argent Ortop Traumatol. 2010; 75: 144-50.
Fakler JK, Ryzewicz M, Hartshorn C, Morgan SJ, Stahel PF, Smith WR: Optimizing the management of Moore type I postero-medial split fracture dislocation of the tibial head: description of the Lobenhoffer approach. J Orthop Trauma. 2007; 21(5): 330-6.
Wahlquist M, Iaguilli N, Ebraheim N, Levine J: Medial tibial plateau fractures: a new classification system. J Trauma. 2007; 63(1): 1418-21.
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(8): 1713-21.
Honkonen SE: Indications for surgical treatment of tibial condyle fractures. Clin Orthop Relat Res. 1994; 302: 199-205.
Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN: Complications after tibia plateau fractures surgery. Injury. 2006; 37(1): 475-84.
Rasmussen PS: Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg. 1973; 55(7): 1331-50.
Yoo BJ, Beingessner DM, Barei DP: Stabilization of the posteromedial fragment in bicondylar tibial plateau fractures: a mechanical comparison of locking and nonlocking single and dual plating methods. J Trauma. 2009; 69(1): 148-55.
Cift H, Cetik O, Kalaycioglu B, Dirikoglu MH, Ozkan K, Eksioglu F: Biomechanical comparison of plate-screw and screw fixation in medial tibial plateau fractures (Schatzker IV). A model study. Orthop Traumatol Surg Res. 2010; 96(1): 263-7.
Zeng ZM, Luo CF, Putnis S, Zeng BF: Biomechanical analysis of posteromedial tibial plateau split fracture fixation. Knee. 2011; 18(1): 51-4.
Houben PF, van der Linden ES, van den Wildenberg FA, Stapert JW: Functional and radiological outcome after intra-articular tibial plateau fractures. Injury. 1997; 28(7): 459-62.
De Boeck H, Opdecam P: Posteromedial tibial plateau fractures. Operative treatment by posterior approach. Clin Orthop Relat Res. 1995; (320): 125-28.
Georgiadis GM: Combined anterior and posterior approaches for complex tibial plateau fractures. J Bone Joint Surg Br. 1994; 76(2): 285-9.
Bhattacharyya T, McCarty LP 3rd, Harris MB, Morrison SM, Wixted JJ, Vrahas MS: The posterior shearing tibial plateau fracture. Treatment and results via a posterior approach. J Orthop Trauma. 2005; 19(5): 305-10.
DuWayne A. Posterior bicondylar tibial plateau fractures. J Orthop Trauma. 2005; 19(2): 73-8.
Bendayan J, Noblin JD, Freeland AE: Posteromedial second incision to reduce and stabilize a displaced posterior fragment that can occur in Schatzker type V bicondylar tibial plateau fractures. Orthopedics. 1996; 19(10): 903-4.
Weil YA, Gardner MJ, Boraiah S, Helfet DL, Lorich DG: Posteromedial supine approach for reduction and fixation of medial and bicondylar tibial plateau fractures. J Orthop Trauma. 2008; 22(5): 357-62.
Sciadini MF, Sims SH: Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type IV tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma. 2012; 27(1): e18-23.