Biological approach to treatment of intra-articular proximal tibial fractures with double osteosynthesis

Abstract

The treatment of intra-articular proximal tibial fractures is associated with complications, and much conflicting literature exists concerning the treatment of choice. In our study, an attempt has been made to develop an ideal and adequate treatment protocol for these intraarticular fractures. The principle of double osteosynthesis, i.e., lateral minimally invasive plate osteosynthesis (MIPO), was combined with a medial external fixator to treat 22 intra-articular proximal tibial fractures with soft tissue injury with a mean follow-up of 25 months. Superficial pin track infection was observed in one case, and no soft tissue breakdown was noted. Loss of articular reconstruction was reported in one case. Bridging callus was seen at 12 weeks (8 weeks-7 months). The principle of substitution or double osteosynthesis, i.e., lateral MIPO, was combined with a medial external fixator and proved to be a fairly good method of fixation in terms of results and complications.Résumé le traitement des fractures articulaires du tibia proximal est associé à un certain nombre de complications. Les traitements sont multiples. Dans notre étude, nous avons souhaité nous diriger vers un protocole adapté à ces fractures intra articulaires. le principe d'une double ostéo-synthèse, c'est-à-dire, ostéosynthèse latérale par voie mini invasive, à l'aide d'une plaque (MIPO) a été combinée avec un fixateur externe par voie interne. 22 patients présentant une telle lésion ont été traités de cette façon avec un suivi moyen de 25 mois. des infections de broches superficielles ont été observées dans un cas sans lésion notable des tissus mous. Un déplacement secondaire articulaire a également été rapporté dans un cas. L'apparition d'un pont osseux se fait généralement à 12 semaines en moyenne (huit semaines à sept mois). le principe d'un tel traitement avec double ostéosynthèse est une bonne méthode pour traiter ces lésions et pour éviter un certain nombre de complications.

Use of a Raft Construct through a Locking Plate without Bone Grafting for Split-Depression Tibial Plateau Fractures

“…[13][14][15] The use of a raft construct through a locking plate provides adequate stability to the subchondral bone without filling the metaphyseal void with a bone graft or bone substitute, and achieves radiological union after a mean of 8 (6)(7)(8)(9)(10)(11)(12)(13)(14) weeks, which is similar to other techniques with bone grafting. 16,17 Complications after bone grafting have been reported. In patients with iliac crest bone grafting, up to 3% developed infection necessitating readmission, up to 22% developed minor complications such as persistant discomfort, cutaneous nerve damage, local wound complications (superficial wound infection, seroma, and haematoma), and up to 38% had pain after 6 months and in some cases beyond 2 years.…”

Proximal tibial fractures: early experience using polyaxial locking-plate technology

“…Previous series of proximal tibia fractures treated with locking plates have shown good results with low complication rates [14]. Table 4 summarises some of the published series of patients with proximal tibia fracture treated with the locking-plate technology as well as the reported major complications.…”

Dual locked plating of unstable bicondylar tibial plateau fractures

“…Zhang et al reported 3 deep infections in their comparative retrospective study of 79 patients [35]. Singh et al reported no wound dehiscence or infection in 22 patients with high energy tibial plateau fractures managed with lateral minimally invasive plate osteosynthesis and a medial external fixator [36]. Despite using staged management with a temporary ex fix in high risk patients, there were 3 cases of superficial and one case of deep infection in this series of patients.…”