Plating as an operative management of intra articular fractures of the upper end of tibia: a prospective clinical study

Authors

  • Namdev Gorgile Department of Orthopaedics, GMC and civil Hospital, Miraj, Maharashtra
  • Vinod Jagtap Department of Orthopaedics, GMC and civil Hospital, Miraj, Maharashtra
  • Yash Shah MIMER Medical College, Talegaon, Pune, Maharashtra
  • Vikas Rokade Department of Orthopaedics, GMC and civil Hospital, Miraj, Maharashtra
  • Girish Bartakke Department of Orthopaedics, GMC and civil Hospital, Miraj, Maharashtra

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20174718

Keywords:

Proximal tibia, Buttress plating, Three column classification system

Abstract

Background: Tibial plateau fracture management is challenging because of the severe displacement of the bony fragments, the concomitant depression and impaction of the cancellous subchondral bone, and the inevitable associated cartilage injury.

Methods: A prospective cohort study of 25 patients who suffered high energy intra-articular fractures of proximal tibia was done and they were diagnosed and classified according to Schatzker’s classification. The study was done to study the outcomes of surgical management of high energy tibial plateau fractures with buttress plate, to achieve anatomical reduction and absolute stable internal fixation to prevent malunion, to achieve early mobilisation, to prevent post-operative knee stiffness and also to determine timing of operation after trauma and sequence of fixation of bicondylar fractures. All patients were treated with open reduction and internal fixation with a buttress plate either a lateral, medial or bicondylar plating.

Results: Average radio-graphic bony union time was 12 weeks. Average full weight bearing time was 13 weeks. Knee stiffness improved with physiotherapy and full range was achieved on an average in 8 weeks, mean range of movement 0-124.5º was achieved. 4 patients (16%) developed infection.

Conclusions: Fractures of upper end of tibia can be treated with the plating technique, to achieve anatomical reduction and stable internal fixation with 82% good functional outcome. The plating technique facilitates early mobilisation of injured joint and attains good range of movements. Minimal mal reduction does not seem to vitiate the results. The infection rate of 16% is of concern with this procedure, but responds well to antibiotics and surgical debridement.

Author Biographies

Namdev Gorgile, Department of Orthopaedics, GMC and civil Hospital, Miraj, Maharashtra

Assistant Professor, Dept of Orthopaedics

Vinod Jagtap, Department of Orthopaedics, GMC and civil Hospital, Miraj, Maharashtra

Assistant Professor, Dept of Orthopaedics

Yash Shah, MIMER Medical College, Talegaon, Pune, Maharashtra

MS Ortho, DNB Ortho, MNAMS,DSM, FSR, Assistant Proffessor and Sports Medicine consultant, Department of Orthopaedics

Vikas Rokade, Department of Orthopaedics, GMC and civil Hospital, Miraj, Maharashtra

Associate Professor, Dept of Orthopaedics

Girish Bartakke, Department of Orthopaedics, GMC and civil Hospital, Miraj, Maharashtra

Professor and Head, Dept of Orthopaedics

References

Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the knee society clinical rating system. Clin Orthop Relat Res. 1989;(248):13-4.

Bennett WF, Browner B. Tibial plateau fractures: a studyof associated soft tissue injury. J Orthop Trauma. 1994;8:183.

Young MJ, Barrack RL. Complications in internal fixation of tibial plateau fractures. Orthop Rev. 1994;23(2):149-54.:

Volpin G, Dowd GS, Stein H, Bentley G. Degenerative arthritis after intra-articular fractures of the knee: long-term results. J Bone Joint Surg. 1990;72B:634.

Fyshe TG. Fractures of the condyles of the tibia immobilized by the Stander splint. Can Med Ass J. 1952;67:103-7.

Dobelle M. A new method closed reduction of fractures of the lateral condyle of the tibia. Amer J Surg. 1941;53:460-2.

Honkonen SE. Indications for surgical treatment of tibial condyle fractures. Clin Orthop. 1994;(302):199-205.

Biggi F, Di Fabio S, D'Antimo C, Trevisani S. Tibial plateau fractures ;Internal fixation with locking plates and MIPO technique. Int J Care Injured. 2010;41:1178–82.

Buchko GM, Johnson DH. Arthroscopy assisted operative management of tibial plateau fractures. Clin Orthop Relat Res 1996;332:29.

Caspari RB, Hutton PM, Whipple TL, Meyers JF. The role of arthroscopy in the management of tibial plateau fractures. Arthroscopy. 1985;1:76.

Stamer DT, Schenk R, Staggers B, Aurori K, Aurori B, Behrens FF. Bicondylar Tibial plateau fractures treated with a hybrid ring external fixator: aPreliminary study. J Orthop Trauma. 1994;8:455.

Martin J, Marsh JL, Nepola JV, Dirschl DR, Hurwitz S, DeCoster TA. Radiographic fracture assessments: which ones can we reliably make? J Orthop Trauma. 2000;14(6):379-85.

Lugo-Olivieri CH, Scott WW Jr, Zerhouni EA. Fluid-fluid levels in injured knees: do they always represent lipohemarthrosis? Radiology. 1996;198(2):499-502.

Jensen DB, Bjerg-Nielsen A, Laursen N. Conventional radiographic examination in the evaluation of sequelae after tibial plateau fractures. Skeletal Radiol. 1988;17(5):330-2.

Moore TM, Harvey JP Jr. Roentgenographic measurement of tibial plateau depression due to fracture. J Bone Joint Surg Am. 1974;56:155-60.

Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. Am J Roentgenol. 1988;151(6):1163-7.

Hohl M, Larson R. Fractures and dislocations of the knee- Fractures Vol. 2 by Rockwood & Green : J.B. Lippincott and Co; 1975: 1158-1178.

Chan PS, Klimkiewicz JJ, Luchetti WT, Esterhai JL, Kneeland JB, Dalinka MK, et al. Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma. 1997;11(7):484-9.

Fanucci E. Computerized tomography assessment of bone damage following injury of the anterior cruciate ligament. Radiol Med (Torino) 1995;89(5):608-12.

Yacoubian SV, Nevins RT, Sallis JG, Potter HG, Lorich DG. Impact of MRI on treatment plan and fracture classification oftibial plateau fractures. J Orthop Trauma. 2002;16(9):632-7.

Kode L, Lieberman JM, Motta AO, Wilber JH, Vasen A, Yagan R. Evaluation of tibial plateau fractures: efficacy of MR imaging compared with CT. Am J Roentgenol. 1994;163(1):141-7.

Schatzker J, McBroom R, Bruce D. The tibial plateau fracture: the Toronto experience 1968“1975. Clin Orthop. 1979;138:94-104.

Cong-Feng Lu. Fixation for Complex Tibial Plateau Fractures. J Orthop Trauma. 2010;24:683–92.

Eggli S, Hartel MJ, Kohl S, Haupt U, Exadaktylos AK, Roder C. Unstable bicondylar tibial plateau fractures: a clinical investigation. J Orthop Trauma 2008;22:673–9.

Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma. 1987;1(2):97-119.

David P, Barei DP, Nork SE, Mills WJ. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma. 2004;18:649.

Bhattacharyya T, McCarty LP 3rd, Harris MB, Morrison SM, Wixted JJ, Vrahas MS, et al. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma. 2005;19:305-10.

Chan KK, Resnick D, Goodwin D, Seeger LL. Posteromedial tibial plateau injury including avulsion fracture of the semimembranosus tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging. Radiology. 1999;211:7.

Downloads

Published

2017-10-25

Issue

Section

Original Research Articles