Incidence and Morphology of the Posteromedial Fragment in Bicondylar Tibial Plateau Fractures

Higgins, Thomas F.; Kemper, Dan; Klatt, Joshua B.

doi:10.1097/bot.0b013e31818f8dc1

Cited by 136 publications

(120 citation statements)

References 28 publications

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“…We note that the morphological characteristics of the complex bicondylar four-quadrant tibial plateau fractures follow a regular pattern, which was also described by others [8][9][10][11][12]. The concave medial plateau is usually split into two large fragments (posteromedial and anteromedial) without articular depression, while the convex lateral plateau is split-depressed into various degrees of multi-fragments with broadening of the lateral compartment (anterolateral and posterolateral).…”

Section: Discussionmentioning

confidence: 63%

“…Chang et al [6,7] classified the tibial articular plateau into four-quadrants, and the fractures are categorized with an isolated single quadrant (anteromedial, anterolateral, posteromedial, and posterolateral) and different combinations of 2, 3 and 4 quadrants. The fracture on each quadrant may have unique characteristics [8][9][10][11][12] as well as require related incision or treatment protocols [13,14].…”

Section: Introductionmentioning

confidence: 99%

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A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Chang

Zhang

et al. 2014

International Orthopaedics (SICOT)

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Purpose Bicondylar tibial plateau fractures involving four articular quadrants are severe and complex injuries, and they remain a challenging problem in orthopaedic trauma. The aim of this study was to introduce a new treatment protocol with dual-incision and multi-plate fixation in the floating supine patient position as well as to report the preliminary clinical results. Methods From January 2006 to December 2011, 16 consecutive patients with closed bicondylar four-quadrant tibial plateau fractures (Schatzker type VI, OTA/AO 41C2/3) were treated with posteromedial inverted L-shaped and anterolateral incisions. With the posteromedial approach, three quadrants (posteromedial, anteromedial and posterolateral) can be exposed, reduced and fixed with multiple small antiglide plates and short screws in an enclosure pattern. With the anterolateral approach, after articular elevation and bone substitute grafting, a strong locking plate with long screws to the medial cortex is used to raft-buttress the reduced lateral plateau fracture, hold the entire reconstructed tibial condyles together, and contact the condyles with the tibial shaft. All patients were encouraged to exercise knee motion at an early stage. The outcome was evaluated clinically and radiologically after a minimum two-year follow-up. Results The average operation time was 98±26 minutes (range 70-128) and the average duration of hospitalization was 29±8.6 days (range 20-41). Three cases used five plates, nine cases used four plates, and four cases used three plates. All patients were followed for a mean of 28.7±6.1 months (range 26-38). Fifteen incisions healed initially, while one patient developed a medial wound dehiscence and was successfully managed by debridement. All patients achieved radiological fracture union after an average of 20.2 weeks. At the two-year follow up, the average knee range of motion (ROM) was 98°±13.7 (range 88-125°), with a Hospital for Special Surgery (HSS) knee score of 87.7±10.3 (range 75-95), and SMFA score of 21.3±8.6 (range 12-33). Conclusion For bicondylar four-quadrant tibial plateau fractures, the treatment protocol of multiple medial-posterior small plates combined with a lateral strong locking plate through dual incisions can provide stable fracture fixation to allow for early stage rehabilitation. Good clinical outcomes can be anticipated.

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Chang

Zhang

et al. 2014

International Orthopaedics (SICOT)

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“…Barei et al [2] and Higgins et al [24] reported that the incidence rate of posteromedial fragments in patients with Bicondylar tibial plateau fractures was 28.8-59%. The presentation of posteromedial fragments makes reduction and fixation of complex plateau fractures more difficult, especially when a single fixed angle plate is used.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

BJSTR

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“…[1][2][3] Evaluation of these fractures with computed tomography and three dimensional (3-D) reconstructions has shown presence of posteromedial fragment in most of these cases. 4 If not treated timely and adequately these fractures can lead to late onset disabilities. With recent change in trends, most of the authors recommend open reduction and internal fixation (ORIF) for these fractures.…”

Section: Introductionmentioning

confidence: 99%

“…5 Several biomechanical studies have proved that fixation of these fragment is necessary to prevent secondary loss of alignment like varus collapse. 4 We have tried to assess the outcome of these fractures using ORIF with locking or buttress plate through Lobenhoffer approach.…”

Section: Introductionmentioning

confidence: 99%

Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures

et al. 2017

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Background: Management of tibial plateau fractures with coronal fractures especially posteromedial fragment is frequent and challenging. This study was conducted to evaluate the functional outcome of patients with tibial plateau fractures having posteromedial fragment treated with open reduction and internal fixation (ORIF) using Lobenhoffer approach.Methods: Thirty two patients with tibial plateau fractures having posteromedial fracture alone or part of bicondylar fracture was operated with ORIF using Lobenhoffer approach. Time to union, maintenance of alignment, rate of complications and functional outcome was assessed using Oxford knee score.Results: The mean time to healing was 16.4 weeks, without any complication in the form of non-union and infection. Malunion with secondary loss of alignment was seen in only one case due to fracture comminution and early weight bearing. Oxford knee score was good to excellent in all the cases. Conclusions: With recent development in understanding these fractures, ORIF gives excellent to good outcome in all patients operated through Lobenhoffer approach. Long term disability can be prevented by maintenance of adequate alignment and reduction through direct visualization of fracture.

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Incidence and Morphology of the Posteromedial Fragment in Bicondylar Tibial Plateau Fractures

Cited by 136 publications

References 28 publications

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

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Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures

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