Arthroscopic management of tibial plateau fractures?comparison with open reduction method

Abstract

The arthroscopic procedure is recommended in selected tibial plateau fractures.

Percutaneous Reduction and Internal Fixation for Monocondylar Fractures of Tibial Plateau: A Systematic Review

“…Finally, 20 papers remained for analysis, of which 17 were in English, 2 in Chinese and 1 in Korean 8,11,13,14,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] . Specifically, there were 2 prospective comparative studies, 2 retrospective comparative studies, 15 case series, and 1 clinical series based on a technique note 8,11,13,14,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] . Levels of evidence (levels I-IV) for each study were examined and distinguished according to the content developed by the OCEBM (15) 6.0 AE1.8 Selection process (15) 11.9 AE2.6 Total score (100) 58.7 AE10…”

“…Specifically, there were 2 Level II studies, 2 Level III studies, and 16 Level IV studies 8,11,13,14,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] . Although 3 studies included a minority (<25%) of patients with complex or bicondylar fractures and should not be included in this review according to the exclusion criteria, the third reviewer finally decided to include these studies considering the fact that the clinical or radiological outcomes of each patient were specifically listed and the data of patients with monocondylar fractures could, therefore, be extracted for analysis 23,26,34 .…”

“…Of the 20 studies, 8 reported a combined of two or three reduction methods for the treatment of tibial plateau fractures 8,19,25,27,29,30,32,34 . A total of 126 patients were treated with the assistance of intraoperative fluoroscopy, 140 patients were treated with the assistance of arthroscopy, and 235 patients were reduced using both fluoroscopy and arthroscopy 8,11,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] . The type of graft material was variable between studies, including autografts, allografts, and bone substitute (mostly calcium phosphate bone cement).…”

“…For monocondylar tibial plateau fractures, one of the most challenging and crucial processes is anatomic restoration of the displaced intra-articular fragments which are depressed downwards into the metaphysis. Traditional open reduction and internal fixation (ORIF) requires an extensive dissection of soft tissues around the fracture zone to achieve better visualization of the displaced articular surface, which carries numerous complications and risks, especially in terms of operation and wound healing 11 . Some authors recommend that arthrotomy and transection of the meniscus should be performed for good visualization during open reduction, which may lead to increased pain, proprioception disorders, and joint stiffness 12 .…”

“…The tibial plateau fractures were classified by the Schatzker classification system in 18 studies 11,13,14,[19][20][21][22][23][24][25][27][28][29][30][31][32][33][34] . Schatzker II and III fractures accounted for the majority of the patients included in these studies, with a proportion of 87.3% (range, 60% to 100%).…”