Article

Arthroscopic-Assisted Reduction with Bilateral Buttress Plate Fixation of Complex Tibial Plateau Fractures

Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.19). 12/2003; 19(9):974-84. DOI: 10.1016/j.arthro.2003.09.038
Source: PubMed

ABSTRACT Our aim was to determine the outcome of arthroscopic-assisted reduction with bilateral buttress plate fixation for the treatment of closed complex tibial plateau fractures.
Case series.
18 consecutive patients (12 men, 6 women) with complex tibial plateau fractures were enrolled in this prospective study. All patients underwent arthroscopic-assisted bilateral buttress plate fixation of closed complex tibial plateau fractures. The average age at operation was 35 years (range, 23 to 45 years). The follow-up period ranged from 39 to 69 months, with an average of 48 months. Using the Schatzker classification, there were 11 type V and 7 type VI fractures. The clinical and radiological outcomes were determined according to Rasmussen's system.
All of the 18 fractures united. Overall, 4 (22%) patients were rated as excellent, 12 (67%) good, and 2 (11%) fair. Secondary osteoarthritis appeared in 3 injured knees (16.7%). One patient had a wound dehiscence (3 cm long) of the medial incision. Condylar joint surface depression was noted in 3 patients without functional instability. Two patients had valgus alignment between 10 degrees and 15 degrees. Two patients had the paresthesia over the lateral calf. There were no complications directly associated with arthroscopy in any of the 18 patients. No deep vein thrombosis, infection, or knee stiffness was found at final follow-up.
Arthroscopic-assisted reduction with bilateral buttress plate fixation for complex tibial plateau fractures allows accurate fracture reduction, diagnosis, and treatment of associated intra-articular lesions, and less dissection than open reduction internal fixation.

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    • "This may have been achieved because the procedure of avoided arthrotomy, with a temporary reduction by manipulation and confirmation of reduction by arthroscopy allowing surgical objectives to be accomplished with minimal damage to the capsule of the joint. On restoration of articular congruity, reduction was maintained with cannulated screws or, when needed, a medial plate applied without arthrotomy [38, 39]. This type of fracture is characterized by many associated injures (5 medial meniscus tears, 3 ACL, 2 PCL and 1 LCL ruptures). "
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