Arthroskopisch unterstütztes Frakturmanagement am Kniegelenk

Enderle, E.; Frosch, Karl‐Heinz

doi:10.1007/s00113-012-2346-1

Cited by 16 publications

(4 citation statements)

References 42 publications

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“…Up to now fractures of the tibia plateau have been mostly treated through open approaches with or without additional arthroscopy like the “fracturoscopy” mentioned by Krause et al 5, 9. Based on the literature and our own experiences, the following indications for arthroscopy-assisted fracture fixation in the knee are considered: (1) simple fractures of the tibial plateau and depression fractures of the tibial plateau, (2) arthroscopic control of reconstruction of the articular surface in complex fractures (fracturoscopy), (3) bony avulsions of the posterior or ACL, (4) osteochondral flakes, (5) therapy of concomitant intra-articular lesions in fractures of the knee joint, and (6) arthroscopy in post-traumatic situations 10 . In particular, simple fractures as classified AO type B1 or B2 are mainly in the central or anterior parts of the plateau, which enable a sufficient arthroscopic visualization, whereas posterolateral depressions or impressions are difficult to visualize by anterior arthroscopic portals.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Controlled Closed Reduction and Percutaneous Fixation of Posterolateral Tibia Plateau Impression Fractures

Ackermann

Frings

Alm

et al. 2019

Arthroscopy Techniques

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Posterolateral impression fractures of the tibial plateau are common, and open reduction and fixation can be demanding, including exposure of the peroneal nerve. Based on a patient example, the surgical technique of an arthroscopic controlled closed reduction and percutaneous screw fixation of a posterolateral tibia plateau impressed fracture is described. A patient sustained a posterolateral impression currently described as an “apple bite” fracture of the tibial plateau. The surgical technique includes standard arthroscopic portals and posteromedial and (transseptal) posterolateral portals. The posterolateral tibial plateau is visualized by incision of popliteomeniscal fibers, retraction of the popliteus tendon, and exposure of the posterolateral plateau. The impression area is marked with a K-wire using an anterior cruciate ligament target device. A cannulated ram is placed over the K-wire. The fracture is lifted under arthroscopic guidance and can be supported with allograft bone chips. To stabilize the reduction, 3 K-wires are positioned from anterior to posterior, and 3 cannulated screws are inserted directly under the joint surface to support the fractured area. In comparison with open surgical techniques, this procedure is exclusively performed under arthroscopic control and enables an anatomic reduction and fixation of the posterolateral tibial plateau.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Controlled Closed Reduction and Percutaneous Fixation of Posterolateral Tibia Plateau Impression Fractures

Ackermann

Frings

Alm

et al. 2019

Arthroscopy Techniques

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“…Dry arthroscopy or "fracturoscopy" using the standard 4.0 mm, 30-degree angled scope, has more recently been advocated for the intraoperative assessment of fracture reduction 50 . In fractures of the posterolateral corner or posterolateral central fragment, it been shown to be superior to fluoroscopy in assessment of reduction 50 , and arthroscopy assisted techniques have been advocated by many surgeons 50,51,52,53,54 . In a very recent cadaveric study by, Behrendt et al 51 on fractures of the latero-central segments of tibial plateau, the authors used fluoroscopy, "fracturoscopy" using a 4.0 mm, 30-degree angled scope, and "nanoscopy" using a 1.9 mm straight scope to assess fracture reduction.…”

Section: Introductionmentioning

confidence: 99%

Management of tibial plateau fractures: a fresh review

KHAN,

MUSHTAQ,

RASHID

et al. 2023

Acta Orthop Belg

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Tibial plateau fractures are complex injuries which carry significant morbidity and economic burden. They can present complex geometry depending upon the direction of the force and position of the limb and are often associated with significant soft-tissue injury. While the goals of adequate reduction, stable fixation, and early mobilization remain unchanged, the management of these injuries can be challenging even to experienced orthopaedic surgeons. Lacking consensus, this review aims to provide a summary of current state of orthopaedic practice in the face of tibial plateau fractures. A PubMed search for relevant recent articles as well as a reading of classical articles on tibial plateau fractures was carried out. The focus remained on articles concerned with management modalities and recent advances. A review of some classification systems was also done and included. A great majority of these fractures need operative fixation while respecting the soft tissues. Numerous methods have been reported in the literature including but not limited to plates, screws, external fixators, arthroscopy assisted methods, balloon-cement tibioplasty, or a combination thereof. There is a shortage of randomized controlled trials comparing various operative methods. This article provides a review of various techniques and latest advances made in the management of tibial plateau fractures. The key to achieving optimal functional outcome is using a tailored approach to the individual patient accounting for factors related to the injury pattern, type of host, surgical skills and experience, and local availability of implant devices while taking care of soft tissue. While there is no gold standard, a staged procedure is recommended with early spanning and definitive fixation at later stage by any appropriate methods while respecting the soft tissue, achieving anatomical reduction and adequate fixation and, early rehabilitation.

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“…Insbesondere bei den mit 34,5 % besonders häufigen bikondylären Frakturen ist die in der Literatur beschriebene Rate für posttraumatische Arthrosen mit 44 % sehr hoch [5,6]. Sofern aufgrund potenziell bestehender Begleitverletzungen möglich, sollte postoperativ eine langfristige Immobilisation vermieden und dem Patienten eine frühfunktionelle Nachbehandlung ermöglicht werden [7].…”

Section: Introductionunclassified

Chirurgische Zugänge zum Tibiakopf

Hissnauer¹,

Krause²,

Frings³

et al. 2019

OP-JOURNAL

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ZusammenfassungIntraartikuläre Tibiakopffrakturen sind häufig komplex und können eine große chirurgische Herausforderung darstellen. Das Ziel der operativen Versorgung ist die anatomische stufenlose Gelenkrekonstruktion. Die Frakturmorphologie erfordert eine frakturspezifische Zugangsstrategie, welche entscheidende Voraussetzung für ein gutes postoperatives Ergebnis ist. Um eine komplette visuelle Einsicht über die frakturierten Gelenkflächen zu erlangen, können die verschiedenen Zugänge kombiniert oder bedarfsweise erweitert werden. Dabei kann durch eine laterale oder mediale femorale Epikondylenosteotomie die Einsicht auf die betroffene Gelenkfläche maßgeblich verbessert werden. Darüber hinaus ist zu beachten, dass dorsale Anteile der Gelenkfläche meist nur mit dorsalen Zugängen visualisiert werden können! Auch die geplante Positionierung von Platten und Schrauben sollte in der Zugangswahl Berücksichtigung finden!

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Arthroskopisch unterstütztes Frakturmanagement am Kniegelenk

Cited by 16 publications

References 42 publications

Arthroscopic Controlled Closed Reduction and Percutaneous Fixation of Posterolateral Tibia Plateau Impression Fractures

Arthroscopic Controlled Closed Reduction and Percutaneous Fixation of Posterolateral Tibia Plateau Impression Fractures

Management of tibial plateau fractures: a fresh review

Chirurgische Zugänge zum Tibiakopf

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