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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    ABSTRACT: Like other intra-articular fractures, the tibial plateau fracture is challenging for orthopedic surgeons because of its severity of trauma, associated soft tissue injuries. Open reduction incurs serious complications, especially wound healing after traditional dissections. Unsatisfactory results often occur in complex or bicondylar tibial plateau fractures. Traditional surgical methods achieved satisfactory results in 70-80% of cases. However, these methods have a high incidence of complications including loss of reduction, infection, and septic arthritis. The advantages of arthroscopy-assisted reduction and internal fixation include direct visualization of intra-articular fracture, accurate fracture reduction, and reduced morbidity. It is straightforward in the diagnosis and treatment of meniscal and ligamentous injuries, and removal of loose fragments. Good early to medium-term results of arthroscopically assisted osteosynthesis of tibial plateau fractures have been reported. The author reviews the current surgical principles, pitfalls, approaches, clinical results, and complications of arthroscopyassisted surgery for tibial plateau fractures.
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