Locking compression plate+T-type steel plate for postoperative weight bearing and functional recovery in complex tibial plateau fractures

Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients.The anatomical relationship between the proximal tibial bone and soft tissue is complex,resulting in different types of tibial plateau fractures.Violent trauma can lead to displaced fracture,serious soft tissue injury,and potentially,dislocation of the knee joint.Therefore,tibial plateau fractures are extremely unstable.AIM To assess the use of locking compression plate(LCP)+T-type steel plate for postoperative weight bearing and functional recovery of complex tibial plateau fractures.METHODS Ninety-seven patients with complex tibial plateau fractures who underwent surgery at our hospital were selected for retrospective study.Forty-nine patients had been treated with LCP+T-type steel plate limited internal fixation(study group),and 48 patients with bilateral ordinary steel plate support(control group).The operation process index,postoperative rehabilitation related index,Rasmussen score of the knee joint,tibial plateau varus angle(TPA),tibial plateau retroversion angle(PA),and surgical complications of the two groups were compared.RESULTS The operation time and intraoperative bone graft volume in the study group were lower than those in the control group(P<0.05).There were no significant differences in surgical bleeding,anterior external incision length,postoperative drainage,hospital stay duration,and fracture healing time between the groups(P>0.05).There was no significant difference in the TPA and PA angle between the groups immediately and 18 mo after surgery(P>0.05).At 12 mo after surgery,the Rasmussen scale score was higher in the study group than in the control group(P<0.05).There was no significant difference in the Rasmussen scale score at 18 mo after surgery,and the radiology score at 12 and 18 mo after surgery,between the two groups(P>0.05).The postoperative complication rate in the study group(3.77%)was lower than that in the control group(15.09%;P<0.05).CONCLUSION LCP+T-type steel plate internal fixation has advantages in terms of minimizing trauma and enabling early postoperative functional exercise,promoting functional recovery and lower limb weight-bearing,and reducing postoperative complications.

Comparison between computed tomography and magnetic resonance imaging in clinical diagnosis and treatment of tibial platform fractures

BACKGROUND Tibial plateau fracture is one of the common fracture types.It occurs mainly in teenagers and is usually caused by a fall.After the occurrence of fracture,knee swelling,pain,limited activity,etc.greatly affect the patient’s exercise habits and lifestyle.X-ray,computed tomography(CT)and magnetic resonance imaging(MRI)were used in this examination.X-rays are relatively new and easy to operate.However,there are some errors in the observation of fracture collapse and fracture displacement.In recent years,CT and MRI have been actively used to diagnose various types of clinical fractures.They have more diagnostic power than X-ray film.However,some scholars believe that CT is also prone to errors in clinical application.The volume effect leads to missed diagnosis and misdiagnosis in some cases,while the multidirection scanning of MRI technology can effectively overcome the shortcomings of CT.To facilitate the selection of clinical examination regimens,this study further observed the diagnostic ability of these two regimens in the diagnosis of tibial plateau fractures.AIM To explore the value of nuclear MRI and CT in the clinical diagnosis of tibial plateau fractures.METHODS A total of 120 patients with tibial plateau fractures admitted from September 2017 to August 2019 were included.All patients were examined by nuclear MRI and CT scanning.The results were sent to senior physicians in our hospital to complete the diagnosis.RESULTS Nuclear magnetic resonance showed the same effects as CT in four aspects:fracture displacement,bone defect,fracture site and fracture comminution.There was no significant difference in the score data(P>0.05).Nuclear magnetic resonance and CT tended to be consistent in the B3,C2 and C3 fracture diagnosis coincidence rate,combined injury detection rate and fracture detection rate.The diagnostic coincidence rate of type B1,B2 and C1 fractures and the accuracy rate of overall fracture classification indicated that the MRI technique was significantly better than that of CT(P>0.05).CONCLUSION MRI and CT have good diagnostic typing in the diagnosis of tibial plateau fractures,but MRI is more accurate and may be preferred.

Artificial Intelligence to Diagnose Tibial Plateau Fractures: An Intelligent Assistant for Orthopedic Physicians

Objective:To explore a new artificial intelligence(AI)-aided method to assist the clinical diagnosis of tibial plateau fractures(TPFs)and further measure its validity and feasibility.Methods:A total of 542 X-rays of TPFs were collected as a reference database.An AI algorithm(RetinaNet)was trained to analyze and detect TPF on the X-rays.The ability of the AI algorithm was determined by indexes such as detection accuracy and time taken for analysis.The algorithm performance was also compared with orthopedic physicians.Results:The AI algorithm showed a detection accuracy of 0.91 for the identification of TPF,which was similar to the performance of orthopedic physicians(0.92±0.03).The average time spent for analysis of the AI was 0.56 s,which was 16 times faster than human performance(8.44±3.26 s).Conclusion:The AI algorithm is a valid and efficient method for the clinical diagnosis of TPF.It can be a useful assistant for orthopedic physicians,which largely promotes clinical workflow and further guarantees the health and security of patients.

Correlation between Surface Area Ratio of Medial to Lateral Tibial Plateau and Knee Alignment in Adults

Objective This study aimed to investigate the correlation between the surface area ratio of medial tibial plateau(MTP)to lateral tibial plateau(LTP)and the mechanical tibiofemoral angle(mTFA).Methods Lower limb computed tomography(CT)images were collected at our hospital.Then,the original CT data were analyzed and reconstructed using medical image processing software.The proximal and distal centres of the femur and tibia were marked.The surface areas of MTP and LTP were identified using image processing software.GraphPad Prism 8.0.2 was used to perform the statistical analysis.Results The surface area ratio of MTP to LTP was significantly correlated with the mTFA in all patients(P<0.0001),male group(P<0.0001),female group(P<0.0001),varus group(P<0.0001),and valgus group(P=0.002).Furthermore,the surface area of MTP and LTP was significantly greater in the male group than in the female group(P<0.0001).There was significant difference in the surface area of the MTP between the varus and valgus groups(P<0.0001).Significant difference was also observed in the surface area ratio of MTP to LTP between the varus and valgus groups(P<0.0001).Conclusion The surface area ratio of MTP to LTP was correlated with the mTFA.Within a certain range,the smaller the mTFA,the greater the surface area ratio of MTP to LTP.For patients undergoing total knee arthroplasty,of whom the surface area of the MTP was basically equal to that of the LTP,it is recommended that the osteotomy should be performed in accordance with mechanical alignment standards,and that a symmetrical tibial plateau prosthesis should be used.For patients whose surface area of MTP is significantly greater than that of the LTP,it is recommended that the osteotomy should be performed in accordance with kinematic alignment standards,and that an anatomical tibial plateau prosthesis should be used.

Lesional and Therapeutic Aspects of Tibial Plateau Fractures at the BSS University Hospital Center in Kati

Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobility of the knee and can compromise walking and standing. These fractures are on the increase, especially affecting young and active subjects. Orthopedic treatment is a rare indication apart from non-displaced or slightly displaced forms. Surgical treatment is required in displaced forms, particularly in depression fractures. The aim of this work was to report the lesional and therapeutic aspects of tibial plateau fractures in our department. Patients and Method: Patients and method: This was a retrospective study over 36 months from January 2019 to December 2021. Included in this study were patients treated for a tibial plateau fracture in our department and followed up for at least 10 months. The epidemiological and clinical data analyzed were age, sex, affected side, etiology, mechanism of injury, pathological anatomy and associated lesions. The fractures were classified according to the classification of Duparc and Ficat. The slightly or non-displaced forms were treated orthopedically while the displaced forms were treated surgically. The minimum follow-up was 10 months. The results were evaluated by the anatomical criteria according to Mazas and Duparc and functional according to Merle d’Aubigné. Results: The authors collected 71 cases of tibial plateau fractures. They accounted for 4.0% of all limb fractures, 5.8% of lower limb fractures and 33.8% of knee fractures in our service. The male sex was the most represented at 78.9% with a sex ratio of 3.7. The age group of [20 - 40] years was the most affected, i.e., 53.5%. The average age was 41 years with extremes of 17 and 82 years. The left side was affected (n = 47) and the right side (n = 24). Road traffic accident was the main cause. The mechanism of injury was mainly represented by lateral and sagittal compressions. Lateral unituberosity and bi-tuberosity fractures were the most frequent pathological types in our series, respectively 42.2% and 28.2%. The associated lesions were mainly represented by bone, ligament, skin and neurological lesions. The treatment was orthopedic in 52.1% and surgical in 47.9%. According to the functional criteria of PMA, our results were very good and good at 77.4%, Average at 14.1% and poor at 8.5%. Conclusion: It appears in this study that fractures of the tibial plateaus are frequent and serious because of their articular nature. Lateral and sagittal compressions are the most evoked injury mechanisms. Lateral unituberosity and bituberosity fractures are the most frequent pathological types. Functional and anatomical results are significantly better with surgical treatment.

Does a staged treatment of high energy tibial plateau fractures affect functional results and bony union?A case series

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.

Magnesium Alloy for Repair of Lateral Tibial Plateau Defect in Minipig Model

Bone graft substitutes are widely-studied as alternatives to bone grafts in the clinic. The currently available products are mostly ceramics and polymers. Considerable progress has been made in the study of the biodegradable magnesium alloys, which possess the necessary attributions of a suitable substitute, including an excellent mechanical property. In the present study, a minipig model of a lateral tibial plateau defect was used to evaluate the effectiveness of a magnesium alloy in the repair of a critical-sized defect. The micro-arc oxidation （MAO）-coated ZK60 alloy tablets and medical-grade calcium sulfate pellets were used as the test and control materials, respectively. Bone morphology was monitored by computed tomography after the implantation for 2 and 4 months. It was found that the bone morphology in minipigs following magnesium treatment was similar to that of the normal bone, whereas an abnormal and concave morphology was displayed following the calcium sulfate treatment. The average bone healing rate for the magnesium-treated defects was higher than that of the calcium sulfate-treated defects at the first 4 months following the implantation. Overall, magnesium treatment appeared to calcium sulfate treatment. Thus, the MAO-coated ZK60 al substitute, and further research on its biological activity in improve the defect repair as compared with the oy appears to be a useful biocompatible bone graft vivo is needed.

Dual split and dislocation——a variant of Schatzker type-I tibial plateau fracture: A case report

Schatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane,consequent to valgus impaction caused by low velocity of trauma.However,a deep understanding of the different columns of the tibial plateau and patho-mechanisms of the injury led to the unmasking of atypical fractures around the tibial plateau.We have encountered 2 cases with unusual fracture pattern of the lateral tibial condyle caused by road traffic accidents.The fracture pattern and severity of injury deviate from the original description of Schatzker type 1;in view of dual plane split,there is rotation of the posterolateral column fragment along its sagittal plane plus grade-III medial collateral ligament injury.The patients were initially treated with knee spanning external fixator and after a latency of 5 days,definitive fracture specific fixation was done,combined with repair of grade-III medial collateral ligament injury.At the 6 months follow-up both the patients achieved satisfactory knee functions(knee society score case 1:100 and case 2:92)and returned to their jobs.The severity of fracture pattern and displacement as described should prompt for examination of associated ligament injury.Because of timely diagnosis,early and appropriate care promised an excellent function outcome even in such a severe nature of knee injury.To prompt the description of injury pattern we coined the name"dual split and dislocation"of lateral tibial plateau,as a complex injury variant of split fracture of lateral tibial plateau fracture.

Tibial Plateau Fracture with Bucket-handle Tears of Both the Medial and Lateral Menisci

Tibial plateau fractures represent approximately 1% of all fractures which have been reported to commonly accompany by soft tissue injuriesY1 Neglect or missed diagnosis of such soft tissue injuries have negative effects on clinical outcome. In this article, we report a rare case of tibial plateau fracture combined with extensive soft tissue injuries, including bucket-handle tears （BHTs） of both the medial meniscus （MM） and the lateral meniscus （LM）. The patient also had an anterior cruciate ligament （ACL） tibial avulsion fracture, which led to the formation of a loose body in the joint. If left untreated, all of these concomitant injuries could cause unpleasant residual symptoms, such as joint locking and loss of extension.

Intraoperative study on anthropometry and gender differences of the proximal tibial plateau at the arthroplasty resection surface

Background The tibial plateau is asymmetric with a larger medial plateau.We observed from clinical practice that the shape of the tibial plateau does not always present a larger medial plateau.Tibial plateau also showed other shapes.The purpose of this study was to analyze the anthropometric data of the proximal tibia in a large group of Chinese patients undergoing total knee arthroplasty and to investigate the morphology of the resected proximal tibial surface and its gender differences.Methods A total of 822 knees （164 males,658 females） from the Chinese population were measured intraoperatively for medial anteroposterior （MAP） and lateral anteroposterior （LAP） dimensions of the resected proximal tibial surface.The difference of MAP and LAP （DML） was also calculated as MAP minus LAP.We then classified the data into three groups based on the DML （＜-2,-2 to 2,and ＞2 mm） to analyze the morphology of the proximal tibia and its distribution between male and female.Results The shape of proximal tibial plateau was of three types：larger medial plateau type,symmetric type,and larger lateral plateau type.There were significant differences between males and females in relation to the shape distribution of the proximal tibial plateau （P ＜0.05）.Most of the proximal tibial plateau was asymmetric,with 517 of 822 （62.9％） tibia having a DML ＞2 mm and 120 of 822 （14.6％） tibia having a DML＜-2 mm.Only 185 of 822 （22.5％） tibia had a DML between-2 and 2 mm.Conclusion The results of this study can be used as a guideline to design tibial components with different DMLs to better match the different anthropometry of the resected tibial surface.

New Developments in Treatments of Tibial Plateau Fractures

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.

Electric scooter injuries:Incidence and injury patterns at a level I trauma center

Purpose:Electric scooters(e-scooters)have become an increasingly popular mode of public transportation in recent years.As the incidence of related injuries rises,it is important to understand specific fracture patterns unique to e-scooters and electric bikes(e-bikes)to help guide management.The purpose of this study was to review the prevalence and describe specific fracture patterns of e-scooter and ebike related injuries at the busiest level 1 trauma center in the borough of Manhattan.Methods:Chart review to determine mechanism of injury was performed on all patients for whom an orthopedic consult was requested from 1/1/2021 to 12/31/2021.All patients whose injuries were sustained due to an e-scooter or e-bike were further reviewed for demographics,injury characteristics including fracture pattern,and definitive injury management.Any patients who had an orthopedic consult placed for a reason other than an acute injury were excluded.Descriptive statistics are reported as frequency(percentage)for categorical variables and means for continuous variables.Results:Of the 1815 orthopedic consults requested,1357(74.8%)were for acute injury management.Of those with acute injuries,119(8.8%)sustained 136 e-scooter or e-bike related injuries.There were 92(77.3%)males at an average age of(33.8±15.7)years.Approximately one-fifth of all patients presented in June 2021(26,21.8%).There was a 9.2%rate of open fractures.The 136 injuries were evenly split between the upper and lower extremities,with 57(47.9%)upper extremity,57(47.9%)lower extremity injuries,and 5(4.2%)concomitant upper and lower extremity injuries.The most common fracture patterns were ankle fractures(16,11.7%),followed by tibial shaft(14,10.2%),tibial plateau(13,9.5%),and radial head fractures(11,8.0%).There was a 33.3%incidence of associated posterior malleolar fractures in the spiral tibial shaft fractures,31.0%of posterior malleolar involvement and 18.8%of isolated vertical medial malleolar fractures in the ankle fractures,and 61.5%of posterior comminution in the tibial plateau fractures.Conclusion:E-scooter and e-bike related injuries have a high incidence of tibial shaft fractures,ankle fractures,tibial plateau fractures,and radial head fractures.There should be a high index of suspicion for posterior and medial involvement in lower extremity fractures sustained due to e-scooter or e-bikes.Identifying specific fracture patterns seen in e-scooter and e-bike related mechanisms will help guide management of these injuries.

Preventable iatrogenic cause of foot-drop in knee injuries with literature review

Purpose Common peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment.Methods We retrospectively reviewed the prospectively collected data of 7 cases of tibial plateau fractures in association with proximal fibula fracture from January 2019 to September 2019 who presented to emergency room of our hospital.Results In addition to fibular neck fracture,the first case had type 6 tibial plateau displaced fracture and the second case had displaced acetabular fracture with instability of knee with tibial tuberosity avulsion.common peroneal nerve palsy developed following application of distal tibial skeletal traction in both the cases.Other 6 such cases remained neurologically intact as traction was not applied to them.Conclusion Such iatrogenic complication could have been prevented if the injury pattern of"concomitant medial and lateral columns"of the proximal leg is kept in mind by the treating surgeon before applying skeletal traction.

The flexibility and convenience of using a standard orthopaedic table in periarticular knee fractures:Allowing ligamentotaxis and improving imaging accessibility

Tibial plateau and distal femoral fractures are common injuries presenting a significant operative challenge.Complexity of the fracture often needs multi-planar surgical access.A combined two-staged procedure is frequently suggested both in supine and prone position to address this issue.However,this will significantly increase the operative time and eventually impact the outcome,in addition to the complications associated with prone positioning.In this study we used a standard orthopaedic table to position these patients in order to grant access to the postro-medial and a postro-lateral structures while the patient stays in supine setup,at the same time,giving the flexibility to change the alignment from valgus to varus and vice versa.This facilitates fracture reduction while addressing the anatomical structure of the knee.A further advantage is the unobstructed imaging access throughout the surgical fixation.This facilitates the reduction in operative time hence leading to a better outcome in these difficult fractures.We tested this positioning technique in more than 40 patients over a 4-year period at two different centres in the United Kingdome.We found that this approach is safe,reproducible and relatively easy to set up in the two centres.

A model for potential non-contact ski injuries of the knee

Broadly accepted is that most knee injuries result from increased vertical forces,usually induced by an incidental ski fall,collision,or a high jump.We present a new non-contact knee injury mechanism that can happen during a ski turn.Such an injury is governed by a sudden inward turn of the inner ski and consequent swing of the inner leg followed by a nearly instant stop when locked by hip and knee joints.The model provides predictive results for a lateral tibial plateau compression fracture because several simplifications have been made.We confirmed that the modelled compression stresses at typical skiing conditions and with typical skiing equipment can provoke serious knee injuries.The awareness of skiers and skiing equipment industry of the described knee injury mechanism can act as an important injury-prevention factor.