Study Of Outcomes Of AO/OTA Type C Proximal Tibia Fractures Operated With Open Reduction And Internal Fixation.
Study Of Outcomes Of Ao/Ota Type C Proximal Tibia Fractures
Keywords:
Proximal Tibia fractures, Tibia Plateau, AO/OTA Type C, Locked Plating, Open ReductionAbstract
Background: Complex Proximal tibia fractures with complete intra-articular extension and metaphyseal comminution (AO/OTA type C) present a difficult treatment challenge. There are many alternatives in treatment of these fractures. Aim: The primary aim of this study was to evaluate the functional and radiologic long-term results of surgically treated (ORIF) complex intra-articular tibial plateau fractures. Methods: 24patients (18 males and 6 females) with AO/OTA type C proximal tibial fractures were studied fromApril 2014 to August 2016. The bony and functional outcome was evaluated according to Knee Society Score. Results: According to Knee Society Score, the results were as follows: - excellent in 20 patients (83%), good in 3 patients (12.5%), fair in 1 patient (4.5%), and poor in no patient (0%). Conclusion: Open Reduction and anatomical reduction is the best, effective and procedure in treatment of complex proximal tibial fractures (AO/OTA Type C). Excellent results can be obtained in trained hand with correct choice of implants. [Bhavik D NJIRM 2017; 8(1): 32-37]
References
1. Lasanianos NG, Garnavos C, Magnisalis E, Kourkoulis S, Babis GC. A comparative biomechanical study for complex tibial plateau fractures: Nailing and compression bolts versus modern and traditional plating. Injury 2013;44:13339
2. Mckee MD, Pirani SP, Stephen DJ. The Canadian Orthopedic Trauma Society, Open reduction andinternal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicentre, prospective, randomized clinical trial. J Bone Joint Surg Am 2006;88:261323.
3. Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev 1994;23:14954.
4. Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: Definition, demographics, treatment rationale andlongterm results of closed traction management or operative reduction. J Orthop Trauma 1987;1:97119.
5. Mallik AR, Covall DJ, Whitelaw GP. Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev 1992;21:14336
6. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res. 1979;138:94 –104
7. Dias JJ, Stirling AJ, Finlay DBL, Gregg PJ. Computerized tomography for tibial plateau fracture. J Bone Joint Surg [Br].1987;69-B:84-88
8. Zura RD, Adams SB, Jeray KJ, Obremskey WT, Stinnett SS, Olson SA. Timing of definitive fixation of severe tibial plateau fractures with compartment syndrome does not have an effect on the rate of infection. J Trauma. 2010;69: 1523–26
9. Anglen J, Kyle RF, Marsh JL, Virkus WW, Watters WC, Keith MW et al. Locking Plates for Extremity Fractures J Am Acad Orthop Surg. 2009; 17:465-72.
10. AO principles of fracture management.
11. Anterior approach to the knee with osteotomy of the tibial tubercle for bicondylar tibial fractures. D L FernandezJ Bone Joint Surg Am Feb 1988, 70 (2) 208-219
12. Surgical Techniques for Complex Proximal Tibial Fractures JasonA. Lowe, MD; Nirmal Tejwani, MD; Brad Yoo, MD; Philip Wolinsky, MD J Bone Joint Surg Am, 2011 Aug 17; 93 (16): 1548 -1559
13. The Tibial Plateau Fracture: The Toronto Experience 1968-1975. SCHATZKER, JOSEPH M.D., B.SC. (MED.), F.R.C.S.(C); MCBROOM, ROBERT M.D.; BRUCE, DAVID B.A.
14. K. Christensen, J. Powell and R. Bucholz, “Early Results of a New Technique for Treatment of High Grade Tibial Plateau Fractures,†Journal of Orthopaedic Trauma, Vol. 4, 1990.
15. S. Singh, P. R. Patel, A. K. Joshi, R. N. Naik, C. Nagaraj and S. Kumar, “Biological Approach to Treatment of Intra- Articular Proximal Tibial Fractures with Double Osteo-synthesis,â€
International Orthopaedics, Vol. 33, No. 1, 2009, pp. 271-274.
16. D. P. Barei, S. E. Nork, W. J. Mills, et al., “Functional Outcomes of Severe Bicondylar Tibial Plateau Fractures Treated with Dual Incisions and Medial and Lateral Plates,†The Journal of Bone and Joint Surgery. Ameri- can Volume, Vol. 88, No. 8, 2006, pp. 1713-1721.
17. Z. Yu, L. Zheng, Y. Zhang, J. Li and B. Ma, “Functional and Radiological Evaluations of High-Energy Tibial Plateau Fractures Treated with Double-Buttress Plate Fixation,†European Journal of Medical Research, Vol. 14, No. 5, 2009, pp. 200-205.
18. C. R. Perry and G. Evans, “New Surgical Approach to Fractures of the Lateral Tibial Plateau,†The Journal of Bone & Joint Surgery, Vol. 66, No. 8, 1984, pp. 1236- 1240.
19. Apley, “Fractures of the Tibial Plateau,†Orthopedic Clinics of North America, Vol. 10, 1979, pp. 61-74.
20. W. J. Mills and S. E. Nork, “Open Reduction and Internal Fixation of High-Energy Tibial Plateau Fractures,†Journal of Orthopaedic Trauma, Vol. 18, No. 10, 2004, pp. 649-657
21. J. T. Watson, “High-Energy Fractures of the Tibial Plateau,†Orthopedic Clinics of North America, Vol. 25, No. 4, 1994, pp. 723-752
22. M. Ali, M. Burton, M. Hashmi and M. Saleh, “Out- come of Complex Fractures of the Tibial Plateau Treated with a Beam-Loading Ring Fixation System,†The Journal of Bone and Joint Surgery, Vol. 85, No. 5, 2003, pp. 691-699
23. J. L. Marsh, S. T. Smith and T. T. Do, “External Fixation and Limited Internal Fixation for Complex Fractures of the Tibial Plateau,†The Journal of Bone and Joint Surgery. American Volume, Vol. 77, No. 5, 1995, pp. 661- 673.
24. Kumar and A. P. Whittle, “Treatment of Complex (Schautzker Type VI) Fractures of the Tibial Plateau with Circular Wire External Fixation: Retrospective Case Re- view,†Journal of Orthopaedic Trauma, Vol. 14, No. 5, 2000, pp. 339-344.
25. R. Jiang, C. Luo, M. Wang, T. Yang and B. Zeng, “A Comparative Study of Less Invasive Stabilization System (LISS) Fixation and Two-Incision Double Plating for the Treatment of Bicondylar Tibial Plateau Fractures,†Knee, Vol. 15, No. 2, 2008, pp. 139-143.
26. E. Strauss, R. Schwarzkopf, F. Kummer and K. Egol, “The Current Status of Locked Plating: The Good,the Bad, and the Ugly,†Journal of Orthopaedic Trauma, Vol. 22, No. 7, 2008, pp. 479-486
27. Y. S. Chan, L. J. Yuan, S. S. Hung, C. J. Wang, S. W. Yu, C. Y. Chen, E. K. Chao and M. S. Lee, “Arthroscopic- Assisted Reduction with Bilateral Buttress Plate Fixation of Complex Tibial Plateau Fractures,†Arthroscopy, Vol. 19, No. 9, 2003, pp. 974-984
28. S. A. Sems, B. A. Levy, K. Dajani, D. A. Herrera and D. C. Templeman, “Incidence of Deep Venous Thrombosis after Temporary Joint Spanning External Fixation for Complex Lower Extremity Injuries,†Journal of Trauma, Vol. 66, No. 4, 2009, pp. 1164-1166.
29. M. Subasi, A. Kapukaya, H. Arslan, E. Ozkul and O. Cebesoy, “Outcome of Open Comminuted Tibial Plateau Fractures Treated Using an External Fixator,†Journal of Orthopaedic Science, Vol. 12, No. 4, 2007, pp. 347-353.
30. J. P. Stannard, T. C. Wilson, D. A. Volgas and J. E. Alonso, “The Less Invasive Stabilization System in the Treatment of Complex Fractures of the Tibial Plateau: Short- Term Results,†Journal of Orthopaedic Trauma, Vol. 18, No. 8, 2004, pp. 552-558.
31. G. Kumar, N. Peterson and B. Narayan, “Bicondylar Tibial Fractures: Internal or External Fixation?†Indian Journal of Orthopaedics, Vol. 45, No. 2, 2011, pp. 116- 124.
32. T. F. Higgins, J. Klatt and K. N. Bachus, “Biomechanical Analysis of Bicondylar Tibial Plateau Fixation: How Does Lateral Locking Plate Fixation Compare to Dual Plate Fixation?†Journal of Orthopaedic Trauma, Vol. 21, No. 5, 2007, pp. 301-306.
33. D. Mahadeva, M. L. Costa and A. Gaffey, “Open Reduction and Internal Fixation versus Hybrid Fixation for Bi- condylar/Severe Tibial Plateau Fractures: A Systematic Review of the Literature,†Archives of Orthopaedic and Trauma Surgery, Vol. 128, No. 10, 2008, pp. 1169-1175.
34. J. A. Lee, S. A. Papadakis, C. Moon and C. G. Zalavras, “Tibial Plateau Fractures Treated with the Less Invasive Stabilization System,†International Orthopaedics, Vol. 31, No. 3, 2007, pp. 415-418.
35. J. P. Stannard, T. C. Wilson, D. A. Volgas and J. E. Alonso, “The Less Invasive Stabilization System in the Treatment of Complex Fractures of the Tibial Plateau: Short- Term Results,†Journal of Orthopaedic Trauma, Vol. 18, No. 8, 2004.
36. K. A. Egol, N. C. Tejwani, E. L. Capla, P. L. Wolinsky and K. J. Koval, “Staged Management of High-Energy Proximal Tibia Fractures (OTA Types 41): The Results of a Prospective, Standardized Protocol,†Journal of Orthopaedic Trauma, Vol. 19, No. 7, 2005, pp. 448-455.
37. J. A. Hall, M. J. Beuerlein and M. D. McKee, “Open Re- duction and Internal Fixation Compared with Circular Fixator Application for Bicondylar Tibial Plateau Fractures,†The Journal of Bone and Joint Surgery. American Volume, Vol. 1, No. 91, 2009, pp. 74-88.
38. S. Eggli, M. J. Hartel, S. Kohl, U. Haupt, A. K. Exadaktylos and C. Röder, “Unstable Bicondylar Tibial Plateau Fractures: A Clinical Investigation,†Journal of Orthopaedic Trauma, Vol. 22, No. 10, 2008, pp. 673-679.
39. S. N. Shah and M. A. Karunakar, “Early Wound Complications after Operative Treatment of High Energy Tibial Plateau Fractures through Two Incisions,†Bulletin of the NYU Hospital for Joint Diseases, Vol. 65, No. 2, 2007, pp. 115-119.
2. Mckee MD, Pirani SP, Stephen DJ. The Canadian Orthopedic Trauma Society, Open reduction andinternal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicentre, prospective, randomized clinical trial. J Bone Joint Surg Am 2006;88:261323.
3. Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev 1994;23:14954.
4. Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: Definition, demographics, treatment rationale andlongterm results of closed traction management or operative reduction. J Orthop Trauma 1987;1:97119.
5. Mallik AR, Covall DJ, Whitelaw GP. Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev 1992;21:14336
6. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res. 1979;138:94 –104
7. Dias JJ, Stirling AJ, Finlay DBL, Gregg PJ. Computerized tomography for tibial plateau fracture. J Bone Joint Surg [Br].1987;69-B:84-88
8. Zura RD, Adams SB, Jeray KJ, Obremskey WT, Stinnett SS, Olson SA. Timing of definitive fixation of severe tibial plateau fractures with compartment syndrome does not have an effect on the rate of infection. J Trauma. 2010;69: 1523–26
9. Anglen J, Kyle RF, Marsh JL, Virkus WW, Watters WC, Keith MW et al. Locking Plates for Extremity Fractures J Am Acad Orthop Surg. 2009; 17:465-72.
10. AO principles of fracture management.
11. Anterior approach to the knee with osteotomy of the tibial tubercle for bicondylar tibial fractures. D L FernandezJ Bone Joint Surg Am Feb 1988, 70 (2) 208-219
12. Surgical Techniques for Complex Proximal Tibial Fractures JasonA. Lowe, MD; Nirmal Tejwani, MD; Brad Yoo, MD; Philip Wolinsky, MD J Bone Joint Surg Am, 2011 Aug 17; 93 (16): 1548 -1559
13. The Tibial Plateau Fracture: The Toronto Experience 1968-1975. SCHATZKER, JOSEPH M.D., B.SC. (MED.), F.R.C.S.(C); MCBROOM, ROBERT M.D.; BRUCE, DAVID B.A.
14. K. Christensen, J. Powell and R. Bucholz, “Early Results of a New Technique for Treatment of High Grade Tibial Plateau Fractures,†Journal of Orthopaedic Trauma, Vol. 4, 1990.
15. S. Singh, P. R. Patel, A. K. Joshi, R. N. Naik, C. Nagaraj and S. Kumar, “Biological Approach to Treatment of Intra- Articular Proximal Tibial Fractures with Double Osteo-synthesis,â€
International Orthopaedics, Vol. 33, No. 1, 2009, pp. 271-274.
16. D. P. Barei, S. E. Nork, W. J. Mills, et al., “Functional Outcomes of Severe Bicondylar Tibial Plateau Fractures Treated with Dual Incisions and Medial and Lateral Plates,†The Journal of Bone and Joint Surgery. Ameri- can Volume, Vol. 88, No. 8, 2006, pp. 1713-1721.
17. Z. Yu, L. Zheng, Y. Zhang, J. Li and B. Ma, “Functional and Radiological Evaluations of High-Energy Tibial Plateau Fractures Treated with Double-Buttress Plate Fixation,†European Journal of Medical Research, Vol. 14, No. 5, 2009, pp. 200-205.
18. C. R. Perry and G. Evans, “New Surgical Approach to Fractures of the Lateral Tibial Plateau,†The Journal of Bone & Joint Surgery, Vol. 66, No. 8, 1984, pp. 1236- 1240.
19. Apley, “Fractures of the Tibial Plateau,†Orthopedic Clinics of North America, Vol. 10, 1979, pp. 61-74.
20. W. J. Mills and S. E. Nork, “Open Reduction and Internal Fixation of High-Energy Tibial Plateau Fractures,†Journal of Orthopaedic Trauma, Vol. 18, No. 10, 2004, pp. 649-657
21. J. T. Watson, “High-Energy Fractures of the Tibial Plateau,†Orthopedic Clinics of North America, Vol. 25, No. 4, 1994, pp. 723-752
22. M. Ali, M. Burton, M. Hashmi and M. Saleh, “Out- come of Complex Fractures of the Tibial Plateau Treated with a Beam-Loading Ring Fixation System,†The Journal of Bone and Joint Surgery, Vol. 85, No. 5, 2003, pp. 691-699
23. J. L. Marsh, S. T. Smith and T. T. Do, “External Fixation and Limited Internal Fixation for Complex Fractures of the Tibial Plateau,†The Journal of Bone and Joint Surgery. American Volume, Vol. 77, No. 5, 1995, pp. 661- 673.
24. Kumar and A. P. Whittle, “Treatment of Complex (Schautzker Type VI) Fractures of the Tibial Plateau with Circular Wire External Fixation: Retrospective Case Re- view,†Journal of Orthopaedic Trauma, Vol. 14, No. 5, 2000, pp. 339-344.
25. R. Jiang, C. Luo, M. Wang, T. Yang and B. Zeng, “A Comparative Study of Less Invasive Stabilization System (LISS) Fixation and Two-Incision Double Plating for the Treatment of Bicondylar Tibial Plateau Fractures,†Knee, Vol. 15, No. 2, 2008, pp. 139-143.
26. E. Strauss, R. Schwarzkopf, F. Kummer and K. Egol, “The Current Status of Locked Plating: The Good,the Bad, and the Ugly,†Journal of Orthopaedic Trauma, Vol. 22, No. 7, 2008, pp. 479-486
27. Y. S. Chan, L. J. Yuan, S. S. Hung, C. J. Wang, S. W. Yu, C. Y. Chen, E. K. Chao and M. S. Lee, “Arthroscopic- Assisted Reduction with Bilateral Buttress Plate Fixation of Complex Tibial Plateau Fractures,†Arthroscopy, Vol. 19, No. 9, 2003, pp. 974-984
28. S. A. Sems, B. A. Levy, K. Dajani, D. A. Herrera and D. C. Templeman, “Incidence of Deep Venous Thrombosis after Temporary Joint Spanning External Fixation for Complex Lower Extremity Injuries,†Journal of Trauma, Vol. 66, No. 4, 2009, pp. 1164-1166.
29. M. Subasi, A. Kapukaya, H. Arslan, E. Ozkul and O. Cebesoy, “Outcome of Open Comminuted Tibial Plateau Fractures Treated Using an External Fixator,†Journal of Orthopaedic Science, Vol. 12, No. 4, 2007, pp. 347-353.
30. J. P. Stannard, T. C. Wilson, D. A. Volgas and J. E. Alonso, “The Less Invasive Stabilization System in the Treatment of Complex Fractures of the Tibial Plateau: Short- Term Results,†Journal of Orthopaedic Trauma, Vol. 18, No. 8, 2004, pp. 552-558.
31. G. Kumar, N. Peterson and B. Narayan, “Bicondylar Tibial Fractures: Internal or External Fixation?†Indian Journal of Orthopaedics, Vol. 45, No. 2, 2011, pp. 116- 124.
32. T. F. Higgins, J. Klatt and K. N. Bachus, “Biomechanical Analysis of Bicondylar Tibial Plateau Fixation: How Does Lateral Locking Plate Fixation Compare to Dual Plate Fixation?†Journal of Orthopaedic Trauma, Vol. 21, No. 5, 2007, pp. 301-306.
33. D. Mahadeva, M. L. Costa and A. Gaffey, “Open Reduction and Internal Fixation versus Hybrid Fixation for Bi- condylar/Severe Tibial Plateau Fractures: A Systematic Review of the Literature,†Archives of Orthopaedic and Trauma Surgery, Vol. 128, No. 10, 2008, pp. 1169-1175.
34. J. A. Lee, S. A. Papadakis, C. Moon and C. G. Zalavras, “Tibial Plateau Fractures Treated with the Less Invasive Stabilization System,†International Orthopaedics, Vol. 31, No. 3, 2007, pp. 415-418.
35. J. P. Stannard, T. C. Wilson, D. A. Volgas and J. E. Alonso, “The Less Invasive Stabilization System in the Treatment of Complex Fractures of the Tibial Plateau: Short- Term Results,†Journal of Orthopaedic Trauma, Vol. 18, No. 8, 2004.
36. K. A. Egol, N. C. Tejwani, E. L. Capla, P. L. Wolinsky and K. J. Koval, “Staged Management of High-Energy Proximal Tibia Fractures (OTA Types 41): The Results of a Prospective, Standardized Protocol,†Journal of Orthopaedic Trauma, Vol. 19, No. 7, 2005, pp. 448-455.
37. J. A. Hall, M. J. Beuerlein and M. D. McKee, “Open Re- duction and Internal Fixation Compared with Circular Fixator Application for Bicondylar Tibial Plateau Fractures,†The Journal of Bone and Joint Surgery. American Volume, Vol. 1, No. 91, 2009, pp. 74-88.
38. S. Eggli, M. J. Hartel, S. Kohl, U. Haupt, A. K. Exadaktylos and C. Röder, “Unstable Bicondylar Tibial Plateau Fractures: A Clinical Investigation,†Journal of Orthopaedic Trauma, Vol. 22, No. 10, 2008, pp. 673-679.
39. S. N. Shah and M. A. Karunakar, “Early Wound Complications after Operative Treatment of High Energy Tibial Plateau Fractures through Two Incisions,†Bulletin of the NYU Hospital for Joint Diseases, Vol. 65, No. 2, 2007, pp. 115-119.
Downloads
Published
2018-01-31
How to Cite
Dalal, B., Damore, K., Tank, P., & Ansari, E. A. (2018). Study Of Outcomes Of AO/OTA Type C Proximal Tibia Fractures Operated With Open Reduction And Internal Fixation.: Study Of Outcomes Of Ao/Ota Type C Proximal Tibia Fractures. National Journal of Integrated Research in Medicine, 8(1), 32–37. Retrieved from http://nicpd.ac.in/ojs-/index.php/njirm/article/view/1166
Issue
Section
Original Articles
