DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20175656

A study of minimally invasive percutaneous plate osteosynthesis for tibial plateau fractures

Ujwal S. Ramteke, Vidyadhar Telang, Nadir Shah, Ayush Singh, Hitesh Mangukiya, Arohi Sharma, Amit Yadav

Abstract


Background: Fractures of proximal tibia involve a major weight-bearing joint and are serious injuries, which, if not treated well, result in functional impairment. To preserve normal knee function one must strive to maintain joint congruity, preserve the normal mechanical axis, ensure joint stability and restore a full range of motion. This is a formidable task to accomplish, especially in the face of associated medical conditions of the patients.

Methods: In our study, 30 cases were selected. Selection of cases were done on the basis of X-rays. Schatzker type I, II, III, IV, V & VI included in study. Criteria for acceptable reduction 1) <5 mm of articular step; 2) <5 mm of articular depression. Each case is referred to one set of tibial plateau fracture, showing distribution of tibia plateau fractures that we treated with MIPPO. Clinical follow-up examination was performed at 4, 6, 10, 12 weeks and 3, 6 months. Clinico-radiological assessment was done at 3 month and grading was done. Patients were evaluated according to grading minimum 3 months after injury.

Results: Our study of 30 tibial plateau fractures confirms that the MIPPO technique is an excellent treatment modality in case of tibial plateau fractures. We observed these fractures mainly in age group of 30-40 years, which were involved in road traffic accident. Tibial plateau fractures seen in elder age group were mainly due to abnormal loading patterns on the leg. We have found oblique views very much informative especially for posterolateral or posteromedial displacement, articular depression which helps to plan the position and direction of screws to be used for fixation.

Conclusions: In view of the excellent results obtained with this technique, we advocate MIPPO over conventional open reduction and internal fixation technique for tibial plateau fracture fixation.


Keywords


Minimally invasive percutaneous plate osteosynthesis, Locking plate, Tibial plateau fractures

Full Text:

PDF

References


Hohl M. Tibial Condylar Fractures. J Bone Joint Surg Am. 1967;49:1455-97.

Apley AC. Fractures of Lateral Tibial Condyle treated with traction and early mobilization. J Bone Joint Surg Am. 1956;38:699-708.

Drennan DB, Locher FG, Maylahn DJ. Fractures of the Tibial Plateau: - treatment by closed reduction and Spica cast. J Bone Joint Surg Am. 1979;61:989-1002.

Schatzker J. The Pathomechanics of Knee Joint. J Bone Joint Surg Am. 1960;42:13.

Rockwood and Green fractures in Adults. Vol 2. 5th Edition. 2001: 1802-1838.

Snell RS. Clinical Anatomy, Knee Joint. 5th edition. 2004: 579-583.

Schatzker J, Bruce MB. The Tibial Plateau Fractures. Toronto Experience. 1968;138:94-104.

Rasmussen PS. Tibial Condylar Fractures- Impairment of Knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am. 1973;55-A:1331-50.

Mills WJ. Internal Fixation of Plateau Fractures. OCNA. 2002;33:77-209.

Duwelinus PJ, Rangitsch MR, Colville MR. Treatment of Tibial Plateau Fracture by Limited Internal Fixation. J Bone Joint Surg. 1997;339: 47-57.

Guadinez RF, Mallick AR, Szporn M. Hybrid External Fixation of Comminuted Tibial Plateau Fractures. J Bone Joint Surg. 1996;328:203-10.

Schuluz DJ, Gynn DR. Fracture of Tibial Plateau: A review of literature. J Bone Joint Surg. 1975;109:166-77.

Sirkin MS, Bono CM, Reilly MC, Behrens FF. Percutaneous Methods of Tibial Plateau Fixation. J Bone Joint Surg. 2000;375:60-8.

Koegh P, Kelly Cashman WF. Percutaneous Screw Fixation of Tibial Plateau Fractures. J Bone Joint Surg Am. 1992;23:387-9.

Marsh JL, Smith ST, Do LT. External Fixation and Limited Internal Fixation of Complex Fractures of Tibial Plateau. J Bone Joint Surg. 1995;77:661-73.

Kennedy J, Bailey WH. Experimental Tibial Plateau Fractures-Studies of the mechanism and a classification. J Bone Joint Surg. 1968;50:1522-34.