The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing...The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.展开更多
Objective: To investigate the value of 3D printing techniques in the treatment of complex tibial plateau fractures. Methods: From September 2016 to September 2018, 28 patients with complex tibial plateau fractures wer...Objective: To investigate the value of 3D printing techniques in the treatment of complex tibial plateau fractures. Methods: From September 2016 to September 2018, 28 patients with complex tibial plateau fractures were treated in our hospital. According to the odevity of hospitalized order, the patients were divided into two groups. Group A used 3D reconstruction, virtually reduction, 3D printing and demonstration of individual fracture model before operation while group B only received conventional process by use X-rays or CT image. Comparison between the two groups was made in operation time, operative blood loss, radiation frequency, surgery instrument cost and knee function score. Results: The follow-up was 14.4 months on average (ranged 6 to 22 months). There was no statistical difference of the surgery instrument cost between the 2 groups (P > 0.05). The operation time of group A was significantly shorter than that of group B (P χ2 = 0.373, P = 0.54). Conclusion: 3D printing techniques can improve surgery effect in complex tibial plateau fractures.展开更多
Objective： To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures. Methods： A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation fro...Objective： To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures. Methods： A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005, including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury. There were 4 cases of type Ⅰ fracture, 12 type Ⅱ, 9 type Ⅲ, 12 type Ⅳ and 2 type Ⅴ according to Schatzker criteria. Firstly, the combined injuries were treated. Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed. Finally, the internal fixation was observed by X-ray equipment. Postoperative management was early motion and delayed weight bearing. Results： All the fractures healed in 3 or 4 months. All patients were followed up for 1 to 5 years after operation.No case had severe complications, such as poor wound healing, infection, osteofascial compartment syndrome and osteoarthfitis. According to the Rasmussen scoring system, 36 cases obtained excellent or good results and the other 3 cases had moderate clinical results. The average score was 26 ± 3. Conclusions： As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture, arthroscopy has many advantages. It can treat associated intraarticular soft tissue components, visualize the chondral surface reduction, lavage the hematoma and smaller loose fragments, decrease soft tissue dissection, reduce the risk of scarring and promote rapid recovery.展开更多
Purpose:Tibial plateau fracture(TPF)is a devastating injury as it shatters lower articular surface of the largest joint.Apart from bony injury,TPF can lead to great soft tissue envelope compromise which affects the tr...Purpose:Tibial plateau fracture(TPF)is a devastating injury as it shatters lower articular surface of the largest joint.Apart from bony injury,TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome.In the present study,clinical results were assessed in cases of high energy TPFs treated in staged manner.Methods:Twenty-three(20 males and 3 females)patients of high energy communited TPFs(Schatzker typeⅤandⅥ)were consecutively treated.1 All the patient had compromise of overlying skin conditions.They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed.Schatzker typeⅠ,Ⅱ,ⅢandⅣwere excluded from the study.Primary survey was done and patient who had head injury,chest and abdominal injury,pelvic injury and contralateral limb injury and open fractures were excluded from the study.The patients were also evaluated in terms of wound complications,axial and rotary alignment of limb,fixation failure,articular congruity and range of motion of the knees and post injury employment.Statistical analysis was done using SPSS software.Results:Maximum follow-up period was 13 months.All the fractures were united at final follow-up.Clinical evaluation was done with the Tegner Lysholm knee scoring scale.2 Excellent results were found in 78%cases and good and fair results in 22%cases.There was significant correlation between range of motion and the Tegner Lysholm knee score(p<0.001,Pearson correlation coefficient=0.741).The correlation between the score and the radiographical union duration was significant(p=0.006,Pearson correlation coefficient=-0.554).Conclusion:A staged treatment plan allows healing of soft tissue envelope,with avoidance of dreadful complications such as compartment syndrome and chronic infection.In addition,a staged treatment strategy does not hamper the fracture reduction,bony union and the functional results.展开更多
Tibial plateau fractures account for 1.66–2.0% of all fractures in adults and about 8% of fractures in the elderly.[1] Tibial plateau fractures should be considered as complex injuries representing a wide fracture sp...Tibial plateau fractures account for 1.66–2.0% of all fractures in adults and about 8% of fractures in the elderly.[1] Tibial plateau fractures should be considered as complex injuries representing a wide fracture spectrum： soft-tissue compromise, neurovascular damage, compartment syndrome, and ligament and meniscus tears, which remain a big challenge, even for experienced orthopedic trauma surgeons. Although the best treatment modality remains controversial, we aimed to present new developments in the treatment of tibial plateau fractures for reference.展开更多
目的探讨关节镜联合C型臂X线机治疗胫骨平台骨折的效果。方法方便选择2017年1月—2022年12月丹阳市人民医院收治的78例胫骨平台骨折患者为研究对象,以随机双盲法分为两组,每组39例。对照组行常规切开复位内固定术,观察组行关节镜联合C型...目的探讨关节镜联合C型臂X线机治疗胫骨平台骨折的效果。方法方便选择2017年1月—2022年12月丹阳市人民医院收治的78例胫骨平台骨折患者为研究对象,以随机双盲法分为两组,每组39例。对照组行常规切开复位内固定术,观察组行关节镜联合C型臂X线机微创内固定术,对两组手术疗效、手术指标、膝关节功能恢复与并发症发生情况进行分析比较。结果观察组手术优良率(97.44%)明显高于对照组(82.05%),差异有统计学意义(χ^(2)=5.014,P<0.05);观察组手术治疗相关指标优于对照组,差异有统计学意义(P均<0.05)。术后6个月两组患者Lysholm、纽约特种外科医院(Hospital for Special Surgery,HSS)评分均升高,且观察组Lysholm、HSS评分明显高于对照组,差异有统计学意义(P均<0.05)。观察组术后并发症总发生率低于对照组,差异有统计学意义(P均<0.05)。结论胫骨平台骨折患者采用关节镜联合C型臂X线机治疗的疗效确切,患者创伤小、术后恢复快、并发症少,且对患者膝关节功能的恢复有着明显的促进作用。展开更多
文摘The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.
文摘Objective: To investigate the value of 3D printing techniques in the treatment of complex tibial plateau fractures. Methods: From September 2016 to September 2018, 28 patients with complex tibial plateau fractures were treated in our hospital. According to the odevity of hospitalized order, the patients were divided into two groups. Group A used 3D reconstruction, virtually reduction, 3D printing and demonstration of individual fracture model before operation while group B only received conventional process by use X-rays or CT image. Comparison between the two groups was made in operation time, operative blood loss, radiation frequency, surgery instrument cost and knee function score. Results: The follow-up was 14.4 months on average (ranged 6 to 22 months). There was no statistical difference of the surgery instrument cost between the 2 groups (P > 0.05). The operation time of group A was significantly shorter than that of group B (P χ2 = 0.373, P = 0.54). Conclusion: 3D printing techniques can improve surgery effect in complex tibial plateau fractures.
文摘Objective： To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures. Methods： A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005, including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury. There were 4 cases of type Ⅰ fracture, 12 type Ⅱ, 9 type Ⅲ, 12 type Ⅳ and 2 type Ⅴ according to Schatzker criteria. Firstly, the combined injuries were treated. Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed. Finally, the internal fixation was observed by X-ray equipment. Postoperative management was early motion and delayed weight bearing. Results： All the fractures healed in 3 or 4 months. All patients were followed up for 1 to 5 years after operation.No case had severe complications, such as poor wound healing, infection, osteofascial compartment syndrome and osteoarthfitis. According to the Rasmussen scoring system, 36 cases obtained excellent or good results and the other 3 cases had moderate clinical results. The average score was 26 ± 3. Conclusions： As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture, arthroscopy has many advantages. It can treat associated intraarticular soft tissue components, visualize the chondral surface reduction, lavage the hematoma and smaller loose fragments, decrease soft tissue dissection, reduce the risk of scarring and promote rapid recovery.
文摘Purpose:Tibial plateau fracture(TPF)is a devastating injury as it shatters lower articular surface of the largest joint.Apart from bony injury,TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome.In the present study,clinical results were assessed in cases of high energy TPFs treated in staged manner.Methods:Twenty-three(20 males and 3 females)patients of high energy communited TPFs(Schatzker typeⅤandⅥ)were consecutively treated.1 All the patient had compromise of overlying skin conditions.They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed.Schatzker typeⅠ,Ⅱ,ⅢandⅣwere excluded from the study.Primary survey was done and patient who had head injury,chest and abdominal injury,pelvic injury and contralateral limb injury and open fractures were excluded from the study.The patients were also evaluated in terms of wound complications,axial and rotary alignment of limb,fixation failure,articular congruity and range of motion of the knees and post injury employment.Statistical analysis was done using SPSS software.Results:Maximum follow-up period was 13 months.All the fractures were united at final follow-up.Clinical evaluation was done with the Tegner Lysholm knee scoring scale.2 Excellent results were found in 78%cases and good and fair results in 22%cases.There was significant correlation between range of motion and the Tegner Lysholm knee score(p<0.001,Pearson correlation coefficient=0.741).The correlation between the score and the radiographical union duration was significant(p=0.006,Pearson correlation coefficient=-0.554).Conclusion:A staged treatment plan allows healing of soft tissue envelope,with avoidance of dreadful complications such as compartment syndrome and chronic infection.In addition,a staged treatment strategy does not hamper the fracture reduction,bony union and the functional results.
文摘Tibial plateau fractures account for 1.66–2.0% of all fractures in adults and about 8% of fractures in the elderly.[1] Tibial plateau fractures should be considered as complex injuries representing a wide fracture spectrum： soft-tissue compromise, neurovascular damage, compartment syndrome, and ligament and meniscus tears, which remain a big challenge, even for experienced orthopedic trauma surgeons. Although the best treatment modality remains controversial, we aimed to present new developments in the treatment of tibial plateau fractures for reference.
文摘目的探讨关节镜联合C型臂X线机治疗胫骨平台骨折的效果。方法方便选择2017年1月—2022年12月丹阳市人民医院收治的78例胫骨平台骨折患者为研究对象,以随机双盲法分为两组,每组39例。对照组行常规切开复位内固定术,观察组行关节镜联合C型臂X线机微创内固定术,对两组手术疗效、手术指标、膝关节功能恢复与并发症发生情况进行分析比较。结果观察组手术优良率(97.44%)明显高于对照组(82.05%),差异有统计学意义(χ^(2)=5.014,P<0.05);观察组手术治疗相关指标优于对照组,差异有统计学意义(P均<0.05)。术后6个月两组患者Lysholm、纽约特种外科医院(Hospital for Special Surgery,HSS)评分均升高,且观察组Lysholm、HSS评分明显高于对照组,差异有统计学意义(P均<0.05)。观察组术后并发症总发生率低于对照组,差异有统计学意义(P均<0.05)。结论胫骨平台骨折患者采用关节镜联合C型臂X线机治疗的疗效确切,患者创伤小、术后恢复快、并发症少,且对患者膝关节功能的恢复有着明显的促进作用。
