Ability of the Schatzker classification to predict posteromedial fragmentation in tibial plateau fractures (original) (raw)
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International Journal of Orthopaedics Sciences, 2019
Posterior column fractures of the tibial plateau are relatively rare, as described by Duparc in his revised classification as less as 5% of the tibial plateau fractures although Barie et al has shown upto 30% incidence among tibial plateau fractures [1]. This posteromedial fragment can exist as a solitary fragment or a part of bicondylar tibia plateau fracture is usually not straightforward to diagnose, usually necessitating a CT scan to establish it's presence and morphology. Study was conducted in department of orthopaedics, at Institute of Medical Science & Research Centre, from march 2017 to January 2019.All cases presenting to the outpatient and emergency department fulfilling the below mentioned criteria were taken up for study. Of 15 patients, Functional outcome was assessed using Oxford knee score 12 patients i.e. 85.7% had excellent outcome, 2 patient's i.e. 10.7% had good and 1 patient i.e. 3.6% had fair results. The mean OKS score was 40 (range 36 to 44) at the end of one year ange of motion > 130 degrees was achieve in 12 patients with rest of the three between 110 to 130 degrees. The commonest cause of tibial plateau fracture was Road Traffic Accident, which accounted to 12 patients i.e. 79% and domestic fall accounted for 3 patients i.e. 21%.Amongst the Road Traffic Accident group, 10 had excellent outcome and 2 had good outcome. Amongst the domestic fall group, 2 had excellent outcome and 1 had fair outcome.
Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures
International Journal of Research in Orthopaedics
Background: Management of tibial plateau fractures with coronal fractures especially posteromedial fragment is frequent and challenging. This study was conducted to evaluate the functional outcome of patients with tibial plateau fractures having posteromedial fragment treated with open reduction and internal fixation (ORIF) using Lobenhoffer approach. Methods: Thirty two patients with tibial plateau fractures having posteromedial fracture alone or part of bicondylar fracture was operated with ORIF using Lobenhoffer approach. Time to union, maintenance of alignment, rate of complications and functional outcome was assessed using Oxford knee score. Results: The mean time to healing was 16.4 weeks, without any complication in the form of non-union and infection. Malunion with secondary loss of alignment was seen in only one case due to fracture comminution and early weight bearing. Oxford knee score was good to excellent in all the cases. Conclusions: With recent development in understanding these fractures, ORIF gives excellent to good outcome in all patients operated through Lobenhoffer approach. Long term disability can be prevented by maintenance of adequate alignment and reduction through direct visualization of fracture.
International Journal of Orthopaedics Sciences, 2021
The main objective of the study is to emphasizes the importance of the postero-medial fragment in the management of the tibial plateau fractures and study the functional outcome in Proximal tibia fracture treated with buttress plating. So accurate reduction and buttressing the fragment is essential for excellent functional outcome. Materials and Methods: It was a single center Retrospective and prospective study. 60 patients, with mean age 50.53 + 13.47, presenting with traumatic fractures of proximal tibial having posteromedial fragment treated with buttress plating via posteromedial approach were included in the study and were followed up for the period of 1-year post-surgery. Anatomical and functional evaluation was done using the modified Rasmussen's clinical and radiological criteria. Results: Mean Rasmussen's Clinical Outcome score was 26.63 ± 2.63 with 53.33% (32 patients) showed excellent clinical outcome and 30% (18 patients) showed good outcome. Mean Rasmussen's Radiological Outcome score was 8.3 ± 0.95 with 60% (36 patients) showed excellent radiological outcome and 33.33% (20 patients) showed good outcome. The correlation between Rasmussen's Clinical and Radiological Score was found to be strongly positive (R=0.76) which was a statistically significant finding (p<0.05). The correlation between Rasmussen's Clinical and Radiological Score with Age of patients was found to be negative (p=0.03). There was a significant difference in Mean Clinical and Radiological Scores of Patients between different classification groups, Highest score were seen in patients with One Column involvement followed by Two column (p <0.05). Conclusion: The study emphasizes the importance of the postero-medial fragment in the management of the tibial plateau fractures. Accurate reduction and buttressing the fragment is essential for excellent functional outcome. The goal of treatment of these fractures aims at stability and perfect articular reduction, both of them are not possible without reduction and fixation of the posteromedial fragment.
International Journal of Orthopaedics Sciences, 2018
Background: The posteromedial fragment of tibial plateau fracture remains unrecognized for a long time, leading to inadequate fixation with conventional methods and resulting in early varus collapse. So our study is to observe any significant change in functional and radiological outcome in tibial condylar fracture with posteromedial fragment fixed with buttress plates. Materials and methods: We studied 20 patients of tibial plateau fracture with posteromedial fragment fixed with buttress plate at Narayan Medical College and Hospital, Jamuhar, Sasaram, from first march 2017 to 28 February 2018. This study was a prospective observational study. Direct posterior approach in prone were employed in six patients and posteromedial approach in supine employed in 14 patients. Early knee mobilisation started on 1 st day weight bearing restricted for 11-13 weeks postoperatively. Minimum 6 months follow up done. Rasmussen clinical and radiological scoring system was used. Results: Age of the patients ranged from 18-70 years with most of patients belong to 31-50yrs of age group who are more prone for road traffic accidents. The majority of the patients were male (M: F = 3:1). The majority of the fractures were found to be type 4(30%) type5 (30%) and type6 (40%) of Schatzker's classification. The functional and radiological outcome were comparable and no statistical difference was found with other study (p>0.05). Conclusion: Fixation of posteromedial fragment of tibial plateau fracture with buttress plate provides high union rates, acceptable complications rates as well as satisfactory clinical outcome and radiological outcome.
Morphological characteristics of posterolateral articular fragments in tibial plateau fractures
Orthopedics, 2013
Treatment of posterolateral tibial plateau fractures is controversial, and information regarding this specific fracture pattern is lacking. The purpose of this study was to elucidate the frequency and morphological features of posterolateral articular fragments in tibial plateau fractures. A retrospective radiographic and chart review was performed on a consecutive series of patients who sustained tibial plateau fractures between May 2008 and August 2012. The articular surface area, maximum posterior cortical height, sagittal fracture angle, and amount of displacement were measured on computed tomography scans using the Picture and Archiving Communication System. Thirty-six (15%) of 242 injuries demonstrated a posterolateral fracture fragment comprising a mean 14.3% of the articular surface of the total tibial plateau (range, 8% to 32%). Mean major articular fragment angle was 23° (range, 62° to -43°), mean maximum posterior cortical height was 29 mm (range, 18 to 42 mm), and mean s...
Injury-international Journal of The Care of The Injured, 2017
Background In this study we describe the morphology of the posteromedial fragment in pertrochanteric fractures using 3D CT scans and answer two questions 1) Do differences exist between the 3D CT appearances of posteromedial fragments and the depictions made in the AO classification 2) Does the posteromedial fragment affect stability in pertrochanteric fractures, in terms of fracture collapse? Methods Preoperative CT scans of eight 31-A1 and fifty 31-A2 fractures were analysed. The presence of PM fragment, its fragmentation, greater trochanter (GT) involvement, lesser trochanter (LT) fragment size (in terms of its posterior and medial extent as well as LT length), LT fragment displacement (in terms of medial displacement and rotation) were determined. All fractures were treated with a DHS. Fracture collapse was determined on postoperative radiographs. The relationship between fracture collapse and patient factors including age, gender, fracture type (A1 versus A2), characteristics of the posteromedial fragment, and the presence of a lateral wall fracture were determined. Results Three out of eight 31-A1 fractures demonstrated a separate GT fragment (three part fracture). Out of the 50 31-A2 fractures, 12 had a single PM fragment, which included the LT and GT in continuity. The more common four part fractures seem to form by further fragmentation of this basic form. In A2 fractures, the GT was almost always broken and the broken fragment comprised a mean 56% of normal GT. The LT fragment involved an average of 74% of the posterior wall, and an average of 36% of the medial wall of the proximal femur. Larger LT fragments were less displaced as compared to smaller fragments. Univariate regression analyses revealed that fracture collapse was significantly correlated with fracture type (A1 versus A2, p 0.036), GT size (p 0.002) and the presence of a lateral wall fracture (p<0.001). Conclusions This study demonstrated some important differences between the 3D CT appearances and AO classification of pertrochanteric fractures. Neither fragmentation of the posteromedial fragment, nor the size of the lesser trochanter fragment was found to predict stability in pertrochanteric fractures. A perioperative lateral wall fracture is the main determinant of stability in these fractures.
BMC Musculoskeletal Disorders
Background Application of a posterior plate for tibia plateau fractures associated with posterior column involvement is becoming a widespread standard practice as previous studies have shown that additional fixation of the posterior column with a posteromedial buttress plate creates strongest fixation in terms of fracture stabilization This study evaluated the clinical and radiological results of patients undergoing surgery for complex tibial plateau fractures involving the posterior column with a posteromedial plate applied via a medial midline incision. Methods Medical records of patients undergoing surgery for Schatzker type IV, V, and VI tibia plateau fractures involving the posterior column in our institution were reviewed retrospectively. Patients with a follow-up of less than 1 year, pathological fractures, posterolateral column fractures requiring separate fixation, and open fractures were excluded from the study. Three-dimensional computed tomography (3D CT) was performed i...
Journal of orthopaedic trauma, 2015
While the posteromedial fragment in tibial plateau fractures is often considered unstable, biomechanical evidence supporting this view is lacking. We aimed to evaluate the stability of the fragment in a cadaver model. Our hypothesis was that under the expected small axial force during rehabilitation and the combined effects of this force with shear force, internal rotation torque and varus moment, the most common posteromedial tibia fragment morphology could maintain stability in early flexion. Axial compression force alone or combined with either posterior shear, internal rotation torque, or varus moment was applied to the femurs of five fresh cadaveric knees. A Tekscan pressure mapping system was used to measure pressure and contact area between the femoral condyles, meniscus, and tibial plateau. A Microscribe 3D digitizer was used to define the three-dimensional positions of the femur and tibia. A 10 mm and then a 20 mm osteotomy was created with a saw at an angle of 30° in the a...
Case Reports in Orthopedics
Medial tibial plateau fractures generally present as simple metaphyseal fractures; however, certain cases may present as comminuted articular fractures. Medial and posteromedial anatomical plates have traditionally been used for their management; nevertheless, not all cases can be successfully managed using these implants. We present a comminuted posteromedial Schatzker type VI tibial plateau fracture case. Direct visualization and subsequent fixation using a posteromedial rim plate were achieved through a posteromedial approach and submeniscal arthrotomy. The adequate joint reduction and the obtained stability allowed satisfactory clinical and radiological outcomes. This variation of the classic posteromedial approach and the use of a posteromedial rim plate provide an alternative when facing comminuted medial tibial plateau fractures.