Complex tibial plateau fractures: a retrospective study and proposal of treatment algorithm

Menghi, Amerigo; Mazzitelli, Giuseppe; Marzetti, Emanuele; Barberio, Francesco; D’Angelo, Emanuela; Maccauro, Giulio

doi:10.1016/s0020-1383(17)30649-6

Cited by 21 publications

(13 citation statements)

References 13 publications

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“…Although a few previous studies had directly quantified this observed relationship, the level of fracture classification could reflect the severity of soft tissue injury to a certain extent [15,16]. In addition, we theorize that fracture type (Schartzker V-VI) probably meant greater technical difficulty, prolonged operative time, and extended exposure of the wound, all of which might increase the chance of bacterial colonization and result in a higher incidence of SSI [17].…”

Section: Discussionmentioning

confidence: 88%

Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study

Zhu

Zhao

et al. 2020

J Orthop Surg Res

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Background: Surgical site infection (SSI) was the most common complication of tibial plateau fracture after open reduction and internal fixation (ORIF). Severe infections even required repeat surgeries, which would cause serious psychological harm to patients and increased the economic burden of treatment. In order to identify the characteristics of the SSI and to avoid the occurrence of SSI, we conducted a prospective study to investigate the incidence and independent risk factors of SSI after ORIF for closed tibial plateau fractures in adults. Methods: This study was performed at a first-level trauma center. From October 2014 to December 2018, the study subjects were adult patients with closed fractures of the tibial plateau, all of whom underwent open reduction and internal fixation (ORIF) treatment. Finally, a total of 1108 patients were followed up. We collected patient demographics information, surgery-related variables, and indexes from preoperative laboratory examinations. Univariate and multivariate logistic analysis models were used to investigate the potential risk factors. Results: Twenty-five patients (2.3%, 25/1108) developed SSI. A total of 15 of 25 infections (60.0%) were due to Staphylococcus aureus and 3 (12.0%) were due to MRSA. Independent risk factors of SSI identified by multivariate logistic analysis model were bone grafting: autograft (OR 6.38; 95% CI 2.155-18.886; p = 0.001) and allograft (OR 3.215; 95% CI 1.009-10.247; p = 0.048), fracture type (Schartzker V-VI) (OR 8.129; 95% CI 2.961-22.319; p < 0.001), aspartate aminotransferase (>40 U/L) (OR 5.500; 95% CI 2.191-13.807; p < 0.001), white blood cell (>10*10 9 /L) (OR 2.498; 95% CI 1.025-6.092; p = 0.044), and anion gap (>16 mmol/L) (OR 8.194; 95% CI 1.101-60.980). Conclusions: We should pay enough attention to patients who carried one or more of these factors at admission and adopt more reasonable treatment strategies to reduce or avoid the occurrence of SSI.

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Section: Discussionmentioning

confidence: 88%

Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study

Zhu

Zhao

et al. 2020

J Orthop Surg Res

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“…Tibial plateau fractures are articular injuries which have a broad spectrum of clinical presentations and are frequently associated with long term complications [1,2]. In recent years these challenging fractures have become a topic of great interest not only regarding their classification but also fixation methods and expected outcomes [3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Revisiting the Schatzker classification of tibial plateau fractures

Kfuri

Schatzker

2018

Injury

192

143

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A B S T R A C TTibial plateau fractures have a broad spectrum of presentations, depending on the mechanism and energy of the trauma. Many classification systems are currently available to describe these injuries. In 1974, Schatzker proposed a classification based on a two-dimensional representation of the fracture. His classification with the six-principles types became one of the most utilized classification systems for tibial plateau fractures. More than four decades after this original publication, we are revisiting each fracture type in the light of information made available by computed tomography, which today comprises a standard tool in assessing articular fractures. The classification we are proposing relies on the fact that the tibial plateau has two anatomical columns, lateral and medial. We are introducing a virtual equator which splits the articular surface in the coronal plane. The equator divides each column into two quadrants, the anterior (A) and the posterior (P). Unicondylar fracture types (I to IV) have now additional modifiers A (anterior) and P (posterior) to describe the exact spatial location of the primary fracture plane. Bicondylar fracture types (V and VI) have the modifiers (A and P) of the main fracture plane for each column, and lateral (L) and medial (M) to denote the column. We are introducing the concept of the main fracture plane. Recognition of the exact location of the principal fracture plane is essential for preoperative planning of patient positioning, surgical approach and for determining where to apply the hardware to achieve stable fixation. The new three-dimensional classification is based on the template of the original Schatzker classification. It covers the mechanism of the injury, the energy of the trauma, the morphologic characteristics of the fracture and its location in three dimensions.

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“…Tibial plateau fractures are common intra-articular fractures, accounting for 1–2% of all fractures and up to 8% of all fractures in the elderly population [1, 2]. Fractures that have an impact on the function and stability of tibial plateau usually require surgery.…”

Section: Introductionmentioning

confidence: 99%

Failure analysis of primary surgery and therapeutic strategy of revision surgery for complex tibial plateau fractures

Song

Wang

et al. 2019

J Orthop Surg Res

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Purpose To analyze the cause of failure of the primary surgery for complex tibial plateau fractures and to define the therapeutic strategy of the revision surgery for the same. Methods Twenty-one cases with failure of primary surgery for complex tibial plateau fractures were treated in our hospital from January 2012 to September 2016. There were 13 males and 8 females with an average age of 39.4 years (ranged between 27 and 58 years). Patients presented with different types of complex tibial plateau fractures like Schatzker type V ( n =9), VI ( n =12), type 41.C1 ( n =9), type 41.C2 ( n =6), and type 41.C3 ( n =6). The therapeutic strategy for revision surgery in individual patients was decided following careful analysis and accurate assessment of the causes of failure of the primary surgery. All the patients were followed-up with Rasmussen radiographic scores and Hospital for Special Surgery (HSS) knee scores. Results All 21 patients underwent clinical and radiological examination after a mean follow-up time of 32.6 months. The average time of fracture healing was 4.5 months (ranged between 3 and 6 months). During the last follow-up, the mean range of motion of knee extension was 2.3° and knee flexion was 123.8°. The mean radiological Rasmussen score was 15.6 points, with an overall success rate of 85.7%. The average HSS knee score was 84.3 points, with an overall success rate of 80.9%. Conclusion The common reasons for the failure of primary surgery of complex tibial plateau fractures were inadequate experience of the surgeon, inaccurate diagnosis and management, improper selection of implants, and poor surgical techniques. The key factors to succeed revision surgery were adequate preoperative evaluation, accurate intraoperative procedures, and proper postoperative rehabilitation. Level of evidence Level IV, case series, treatment study

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Complex tibial plateau fractures: a retrospective study and proposal of treatment algorithm

Cited by 21 publications

References 13 publications

Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study

Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study

Revisiting the Schatzker classification of tibial plateau fractures

Failure analysis of primary surgery and therapeutic strategy of revision surgery for complex tibial plateau fractures

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