Complications associated with hyperextension bicondylar tibial plateau fractures: a retrospective study

Bu, Guoyun; Sun, Weitang; Lu, Yandong; Cui, Meng; Zhang, Xi; Lü, Jie; Zhang, Jinli; Sun, Jing

doi:10.1186/s12893-021-01215-1

Cited by 12 publications

(11 citation statements)

References 18 publications

(27 reference statements)

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“…Complex tibial plateau fractures frequently happen due to high‐energy violence, such as car or bicycle accidents. They are often accompanied by severe comminution, substantial soft tissue damage, or neurovascular injury 2,3 . With the development of the classification of tibial plateau fractures, different surgical protocols for various types of fractures emerged.…”

Section: Introductionmentioning

confidence: 99%

Importance of the Posterior Plate in Three‐Column Tibial Plateau Fractures: A Finite Element Analysis and Clinical Validation

Liu,

Hu,

Chang

et al. 2024

Orthopaedic Surgery

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ObjectiveDual‐plate fixation was thought to be the gold standard for treating complicated bicondylar tibial plateau fractures, yet it was found to be hard to accommodate the posterior column in three‐column fractures. Currently, column‐specific fixation is becoming more and more recognized, but no comprehensive investigation has been performed to back it up. Therefore, the objective of this study was to validate the importance of posterior column fixation in the three‐column tibial fractures by a finite element (FE) analysis and clinical study.MethodsIn FE analysis, three models were developed: the longitudinal triple‐plate group (LTPG), the oblique triple‐plate group (OTPG), and the dual‐plate group (DPG). Three loading scenarios were simulated. The distribution of the displacement and the equivalent von Mises stress (VMS) in each structure was calculated. The comparative measurements including the maximum posterior column collapse (MPCC), the maximum total displacement of the model (MTD), the maximum VMS of cortical posterior column (MPC‐VMS), and the maximum VMS located on each group of plates and screws (MPS‐VMS). The clinical study evaluated the indicators between the groups with or without the posterior plate, including operation time, blood loss volume, full‐weight bearing period, Hospital for Special Surgery Knee Scoring system (HSS), Rasmussen score, and common postoperative complications.ResultsIn the FE analysis, the MPCC, the MPC‐VMS, and the MTD were detected in much lower amounts in LTPG and OTPG than in DPG. In comparison with DPG, the LTPG and OTPG had larger MPS‐VMS. In the clinical study, 35 cases were included. In the triple‐plate (14) and dual‐plate (21) groups, the operation took 115.6 min and 100.5 min (p < 0.05), respectively. Blood loss in both groups was 287.0 mL and 206.6 mL (p < 0.05), and the full‐weight bearing period was 14.5 weeks and 16.2 weeks (p < 0.05). At the final follow‐up, the HSS score was 85.0 in the triple‐plate group and 77.5 in the dual‐plate (p < 0.05), the Rasmussen score was 24.1 and 21.6 (p < 0.05), there were two cases with reduction loss (9.5%) in the dual‐plate group and one case of superficial incision infection found in the triple‐plate group.ConclusionThe posterior implant was beneficial in optimizing the biomechanical stability and functional outcomes in the three‐column tibial plateau fractures.

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Section: Introductionmentioning

confidence: 99%

Importance of the Posterior Plate in Three‐Column Tibial Plateau Fractures: A Finite Element Analysis and Clinical Validation

Liu,

Hu,

Chang

et al. 2024

Orthopaedic Surgery

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“…Firoozabadi et al [5] summarized the fracture characteristics and xation strategy of hyperextension varus bicondylar tibial plateau fracture in a 2016 study, and described the radiographic hallmarks of this pattern including sagittal plane malalignment with loss of the normal posterior slope of the tibial plateau, tension failure of the posterior cortex, compression of the anterior cortex and varus deformity in the coronal plane. In addition, due to the particular injury pattern of this fracture, the incidence of associated injuries including vascular, nerve, and posterior cruciate ligament or posterolateral complex injuries as well as diagonal injuries is relatively high [5][6][7], which eventually impair knee joint stability [8].…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis and clinical efficacy of hyperextension bicondylar tibial plateau fractures fixed by medial and lateral dual plates and spinal cage

Huang

et al. 2023

Preprint

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Purpose To elucidate the biomechanical characteristics of fracture defect filled with spinal cage by finite element analysis, and investigate the clinical efficacy of medial and lateral dual plates with spinal cage for the treatment of hyperextension bicondylar tibial plateau fractures. Methods A 10-mm cuneiform defective osteotomy of proximal tibia was created in the finite element model to simulate hyperextension bicondylar tibial plateau fractures. The defect area in the established model was filled with spinal cage (Group A) or allograft bones (Group B) after fracture reduction. The biomechanical properties of both models were tested under axial compression loading and the maximum displacement of the fragments was recorded. Furthermore, a retrospective analysis was conducted on 12 patients with hyperextension bicondylar tibial plateau fractures who were surgically treated at the Lower Limb Surgery Ward of Traumatic Orthopedic Department, Xi’an Honghui Hospital from January 2020 to January 2022. The gender, age, cause of injury, associated injury, the preoperative and postoperative posterior tibial slope angle (pTSA), duration between injury and operation, surgical duration, intraoperative blood loss, complications, time of bone healing, time of weight bearing, Rasmussen radiological criteria and HSS scores were collected and analyzed. Results The finite element model showed that the maximum displacement in Group A was 0.1006 mm and that in Group B was 0.1203 mm, whereas the maximum stress in the two groups were 39.70 MPa and 43.69 MPa respectively. Therefore, implantation of spinal cage into the bone defect area after fracture reduction has obvious biomechanical advantages. We also analyzed 12 patients (9 males and 3 females, aged ranging from 27 to 66 years with mean age of 46.0 ± 12.3 years) with Schatzker type VI fractures. The patients were successfully followed up for an average of 12.50 ± 3.37 months (8 to 18 months). The postoperative pTSA was significantly improved related to the preoperative pTSA (P < 0.001). The average duration between injury and operation was 6.08 ± 2.78 days, the average surgical duration was 131.67 ± 32.71 min, and the average intraoperative blood loss was 320.83 ± 113.73ml. Furthermore, the average time of bone healing was 13.58 ± 2.57 weeks and the average time of weight-bearing was 8.33 ± 2.93 weeks. In addition, 33.33% of postoperative complications was observed in 1 case of superficial wound infection and dehiscence, 1 case of delayed union combined with limited range of motion of the knee joint and 2 cases of deep vein thrombosis. The excellent and good rates of Rasmussen radiological criteria and HSS scores were 83.33% and 91.67% respectively. Conclusion Fracture reduction and fixation by medial and lateral dual plates and spinal cage is an effective method for the treatment of hyperextension bicondylar tibial plateau fractures, and has biomechanical advantages such as favorable bone healing time, weight bearing time, radiographic and clinical functional outcomes.

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“…Firoozabadi et al [5] summarized the fracture characteristics and xation strategy of hyperextension varus bicondylar tibial plateau fracture in a 2016 study, and described the features including sagittal plane deformity of abnormal posterior tibial slope angle, fracture of the posterior cortex, compression of the anterior rim and varus deformity in the coronal plane. In addition, due to the particular injury pattern of this fracture, the incidence of associated injuries including vascular, nerve, and posterior cruciate ligament or posterolateral complex injuries as well as diagonal injuries is relatively high [5][6][7], which eventually impair knee joint stability [8].…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of hyperextension bicondylar tibial plateau fractures fixed by medial and lateral dual plates and spinal cage

Huang

et al. 2023

Preprint

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Background To investigate the clinical efficacy of medial and lateral dual plates with spinal cage for the treatment of hyperextension bicondylar tibial plateau fractures.Methods A retrospective analysis was conducted on 12 patients with hyperextension bicondylar tibial plateau fractures who were surgically treated at the Lower Limb Surgery Ward of Traumatic Orthopedic Department, Xi’an Honghui Hospital from January 2020 to January 2022. The gender, age, cause of injury, associated injury, the preoperative and postoperative posterior tibial slope angle (pTSA), duration between injury and operation, surgical duration, intraoperative blood loss, complications, time of bone healing, time of weight bearing, Rasmussen radiological criteria and HSS scores were collected and analyzed.Results We analyzed 12 patients (9 males and 3 females, aged ranging from 27 to 66 years with mean age of 46.0 ± 12.3 years) with Schatzker type VI fractures. The patients were successfully followed up for an average of 12.50 ± 3.37 months (8 to 18 months). The postoperative pTSA was significantly improved related to the preoperative pTSA (P < 0.001). The average duration between injury and operation was 6.08 ± 2.78 days, the average surgical duration was 131.67 ± 32.71 min, and the average intraoperative blood loss was 320.83 ± 113.73ml. Furthermore, the average time of bone healing was 13.58 ± 2.57 weeks and the average time of weight-bearing was 8.33 ± 2.93 weeks. In addition, 33.33% of postoperative complications was observed in 1 case of superficial wound infection and dehiscence, 1 case of delayed union combined with limited range of motion of the knee joint and 2 cases of deep vein thrombosis. The excellent and good rates of Rasmussen radiological criteria and HSS scores were 83.33% and 91.67% respectively.Conclusion Fracture reduction and fixation by medial and lateral dual plates and spinal cage is an effective method for the treatment of hyperextension bicondylar tibial plateau fractures, which showed advantages such as favorable bone healing time, weight bearing time, radiographic and clinical functional outcomes.

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Complications associated with hyperextension bicondylar tibial plateau fractures: a retrospective study

Cited by 12 publications

References 18 publications

Importance of the Posterior Plate in Three‐Column Tibial Plateau Fractures: A Finite Element Analysis and Clinical Validation

Importance of the Posterior Plate in Three‐Column Tibial Plateau Fractures: A Finite Element Analysis and Clinical Validation

Finite element analysis and clinical efficacy of hyperextension bicondylar tibial plateau fractures fixed by medial and lateral dual plates and spinal cage

Clinical efficacy of hyperextension bicondylar tibial plateau fractures fixed by medial and lateral dual plates and spinal cage

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