Interference Screw Technique for Arthroscopic Reduction and Internal Fixation of Compression Fractures of the Tibial Plateau

Lubowitz, James H.; Vance, Kennan; Ayala, Mina; Guttmann, Dan; Reid, John B.

doi:10.1016/j.arthro.2006.04.110

Cited by 16 publications

(7 citation statements)

References 6 publications

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“…The technique of using a transtibial interference screw for fracture fixation of pure depression fractures of the tibial plateau was described in 2006 [ 5 ], but no clinical or biomechanical data has since been published to support its use. Previous studies have compared the number and size of subchondral screws used in traditional fixation, and the benefits of the use of bone graft, cement or trabecular metal to support elevated fragments [ 6 - 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…More recently a newer method of fixation has been described which involves the use of an interference screw placed beneath elevated bone fragments in place of traditional transverse subchondral screws [ 5 ]. Use of an interference screw allows simultaneous, precise fracture reduction under direct arthroscopic visualization and reamed metaphyseal bone can be used as autograft.…”

Section: Introductionmentioning

confidence: 99%

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A biomechanical study comparing two fixation methods in depression fractures of the lateral tibial plateau in porcine bone

Blakey

Rennison

Guy

et al. 2013

BMC Sports Sci Med Rehabil

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BackgroundA novel method of fixation has been described for the treatment of pure depression fractures of the lateral tibial plateau. Fracture fragments are elevated through a reamed transtibial tunnel. An interference screw is then passed into the tunnel to buttress fracture fragments from beneath. This method of fixation has perceived benefits but there have been no studies to demonstrate that the technique is biomechanically sound. The aim of our study is to compare traditional parallel, subchondral screw fixation with the use of an interference screw, assessing maintenance of fracture reduction following simulated post-operative loading, and overall construct strength.MethodsDepression fractures of the lateral tibial plateau were simulated in 14 porcine knees. Fracture fragments were elevated through a reamed transtibial tunnel and samples were randomly assigned to a fixation method. 7 knees underwent traditional fixation with parallel subcortical cannulated screws, the remainder were stabilized using a single interference screw passed through the transtibial tunnel. Following preloading, each tibia was cyclically loaded from 0 to 500 Newtons for 5,000 cycles using a Nene testing machine. Displacement of the depressed fracture fragments were measured pre and post loading. Samples were then loaded to failure to test ultimate strength of each construct.ResultsThe depression displacement of the fractures fixed using cannulated screws was on average 0.76 mm, in comparison to 0.61mm in the interference screw group (p=0.514). Mechanical failure of the cannulated screw constructs occurred at a mean of 3400 N. Failure of the transtibial interference screw constructs occurred at a mean of 1700 N (p<0.01). In both groups the mechanism of ultimate failure was splitting of the tibial plateau.ConclusionThese results demonstrate the increased biomechanical strength of parallel, cannulated screws for depression fractures of the tibial plateau, however the use of a transtibial interference screw may be a viable method of fixation under physiological loads.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A biomechanical study comparing two fixation methods in depression fractures of the lateral tibial plateau in porcine bone

Blakey

Rennison

Guy

et al. 2013

BMC Sports Sci Med Rehabil

View full text Add to dashboard Cite

show abstract

“…[1][2][3]11 This technique also eliminates the necessity for a second operation performed for implant removal and eliminates the risk of skin irritation over the implants. A similar technique was described by Lubowitz et al 12 In our technique, we use more BioComposite interference screws, potentially creating more stable support beneath the fracture. Their second purpose is to fulfill the bony void created during the procedure, so no autologous bone graft or bone substitutes are required.…”

Section: Discussionmentioning

confidence: 99%

“…A similar technique was described by Lubowitz et al. 12 In our technique, we use more BioComposite interference screws, potentially creating more stable support beneath the fracture. Their second purpose is to fulfill the bony void created during the procedure, so no autologous bone graft or bone substitutes are required.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopy-Assisted Management of Schatzker Type III Lateral Tibial Plateau Fracture With Interference Screw Fixation

Hermanowicz¹,

Mrozek²,

Góralczyk³

et al. 2021

Arthroscopy Techniques

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Tibial plateau fractures occur in both old and young patients and may be caused by low-energy trauma, as well as high-energy trauma. Owing to the variety of injury mechanisms and fracture patterns, tibial plateau fractures are very challenging to treat. One of the most demanding fractures is the type III fracture according to the Schatzker classification, which is a pure depression of the lateral tibial plateau. Treatment with open surgical procedures is associated with vast soft-tissue trauma and prolonged recovery after surgery. Although soft-tissue trauma is minimized and visual control is improved throughout arthroscopy-assisted surgical procedures, internal fixation using buttress plates or lag screws is still required to reduce and fix the depressed plateau. We present an arthroscopy-assisted technique of reduction and fixation of the lateral tibial plateau fracture with 3 BioComposite interference screws (Arthrex, Munich, Germany) that provides a high amount of stability and reduces patient immobilization, allowing for faster rehabilitation.

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“…The advantage of arthroscopically-assisted osteosynthesis of fractures of the tibial plateau are direct visualization of intra-articular fractures, accurate fracture reduction, reduced morbidity in comparison with arthrotomy, simplified diagnosis and treatment of meniscal and ligamentous injuries, thorough-joint lavage, and removal of loose fragments [10][11][12][13][14][15][16]. Good early to medium-term results of arthroscopically-assisted osteosynthesis of tibial plateau fractures have been reported previously [10,11,[17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Arthroscopy-Assisted Corrective Osteotomy, Reduction, Internal Fixation and Strut Allograft Augmentation for Tibial Plateau Malunion or Nonunion

Wang

Cheng

Chen

et al. 2020

JCM

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Purpose: The purpose of this study was to present the results of arthroscopy-assisted corrective osteotomy (AACO), reduction, internal fixation, and strut allograft augmentation for tibial plateau malunion or nonunion. Methods: Fifty-eight patients, mean age 49 ± 11.9 years old, with tibial plateau malunion (n = 44) or nonunion (n = 14), were included in this study. There were 19 Schatzker type II fractures (32.7%), 2 type III fractures (3.4%), 7 type IV fractures (12%), 20 type V fractures (34.5%), and 10 type VI fractures (17.2%). The mean follow-up period was 46.2 ± 17.6 months. Clinical and radiologic outcomes were scored by the Rasmussen system. Articular depression was measured from computed tomography. Secondary osteoarthritis was diagnosed when radiographs showed a narrowed joint space in the injured knee at follow-up. Results: Mean clinical score improved from 15.4 ± 3.9 (pre-revision) to 23.2 ± 4.5 (post-revision). Mean radiologic score improved from 7.7 ± 2.5 (pre-revision) to 12.0 ± 3.9 (post-revision). Fifty-six fractures achieved successful union. The average union time was 19.6 ± 7.5 weeks. Post-revision, 81% had good or excellent clinical results and 62% had good or excellent radiological results. Secondary osteoarthritis (OA) was noted in 91% of all injured knees, where 25.8% were mild OA, 25.8 % were moderate OA, and 38% were severe OA. There were 6 cases of deep infection (10.3%) and 1 case of wound edge necrosis (1.7%). Five cases were converted to total knee replacement after the index surgery with an average period of 13.5 months (range 8–24 months). Conclusions: Arthroscopy-assisted corrective osteotomy, reduction, internal fixation, and strut allograft augmentation can restore tibial plateau malunion/nonunion with well-documented radiographic healing and good clinical outcomes.

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Interference Screw Technique for Arthroscopic Reduction and Internal Fixation of Compression Fractures of the Tibial Plateau

Cited by 16 publications

References 6 publications

A biomechanical study comparing two fixation methods in depression fractures of the lateral tibial plateau in porcine bone

A biomechanical study comparing two fixation methods in depression fractures of the lateral tibial plateau in porcine bone

Arthroscopy-Assisted Management of Schatzker Type III Lateral Tibial Plateau Fracture With Interference Screw Fixation

Arthroscopy-Assisted Corrective Osteotomy, Reduction, Internal Fixation and Strut Allograft Augmentation for Tibial Plateau Malunion or Nonunion

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