Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures

Dreumel, R.L.M. van; Wunnik, B.P.W. van; Janssen, Loes; Simons, Paul; Janzing, H

doi:10.1016/j.injury.2015.05.035

Cited by 113 publications

(107 citation statements)

References 27 publications

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“…One was a randomised controlled trial (RCT)[11], 7 were prospective cohort studies[14,16,25,26,28,30,32], 16 were retrospective cohort studies[12,13,15,17,18,20-24,27,29,34-37] and 3 were case series[19,31,33]. …”

Section: Resultsmentioning

confidence: 99%

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Return to sport following tibial plateau fractures: A systematic review

Robertson¹,

Wong²,

Wood³

2017

WJO

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AIMTo systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.METHODSA systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords “tibial”, “plateau”, “fractures”, “knee”, “athletes”, “sports”, “non-operative”, “conservative”, “operative”, “return to sport”. All studies which recorded return rates and times to sport following tibial plateau fractures were included.RESULTSTwenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management (n = 3); 27 reported on the outcome of surgical management (n = 917). Nine studies reported on Open Reduction Internal Fixation (ORIF) (n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation (ARIF) (n = 253) and 7 on Frame-Assisted Fixation (FRAME) (n = 262). All studies recorded “return to sport” rates. Only one study recorded a “return to sport” time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF (OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME (OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME (OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo (median), from a study reporting on ORIF.CONCLUSIONReturn rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation.

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Section: Resultsmentioning

confidence: 99%

“…Three studies used the Hohl and Moore Classification alone[14,19,24]. Twelve used both the AO/OTA and the Schzakter Classification[11,12,15,16,21,23,25,26,31,33,34,36]. One study reported on postero-lateral tibial plateau fractures with no classification used[18].…”

Section: Resultsmentioning

confidence: 99%

Return to sport following tibial plateau fractures: A systematic review

Robertson¹,

Wong²,

Wood³

2017

WJO

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“…In literature, this complication has been reported between 0% and 59% 25, 26, 27. The large variation in reporting could be due to different criteria used for evaluation, reliability of techniques used for measuring and quality of radiographs used for the purpose of evaluation.…”

Section: Discussionmentioning

confidence: 99%

Complications in the management of closed high-energy proximal tibial plateau fractures

Khatri

Goyal

et al. 2016

Chinese Journal of Traumatology

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PurposeTo report complications in the management of complex closed proximal tibial fractures.MethodA retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted.ResultsThe overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention.ConclusionProximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

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“…Function and quality of life are usually evaluated through specific knee questionnaires, but there is no satisfactory specific post-fracture evaluation system. Analysis of the results of a group of 71 surgically-treated TPF patients to whom the Knee Injury and Osteoarthritis Outcome Score (KOOS) was applied, at a mean follow-up of 6.17 years, 46 showed no correlation between anatomical/non-anatomical reduction and function. Scoring referring to pain, activities of daily living, sports-recreation and quality of life shows worse results in partial articular than in complete articular fractures.…”

Section: What Outcomes Can Be Expected?mentioning

confidence: 99%

Treatment strategy for tibial plateau fractures: an update

2016

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Tibial plateau fractures are complex injuries produced by high- or low-energy trauma. They principally affect young adults or the ‘third age’ population.These fractures usually have associated soft-tissue lesions that will affect their treatment. Sequential (staged) treatment (external fixation followed by definitive osteosynthesis) is recommended in more complex fracture patterns. But one should remember that any type of tibial plateau fracture can present with soft-tissue complications.Typically the Schatzker or AO/OTA classification is used, but the concept of the proximal tibia as a three-column structure and the detailed study of the posteromedial and posterolateral fragment morphology has changed its treatment strategy.Limb alignment and articular surface restoration, allowing early knee motion, are the main goals of surgical treatment. Partially articular factures can be treated by minimally-invasive methods and arthroscopy is useful to assist and control the fracture reduction and to treat intra-articular soft-tissue injuries.Open reduction and internal fixation (ORIF) is the gold standard treatment for these fractures. Complex articular fractures can be treated by ring external fixators and minimally-invasive osteosynthesis (EFMO) or by ORIF. EFMO can be related to suboptimal articular reduction; however, outcome analysis shows results that are equal to, or even superior to, ORIF. The ORIF strategy should also include the optimal reduction of the articular surface.Anterolateral and anteromedial surgical approaches do not permit adequate reduction and fixation of posterolateral and posteromedial fragments. To achieve this, it is necessary to reduce and fix them through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement.Some authors have also suggested that primary total knee arthroplasty could be an option in specific patients and with specific fracture patterns.Cite this article: Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev 2016;1:225-232. DOI: 10.1302/2058-5241.1.000031.

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Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures

Cited by 113 publications

References 27 publications

Return to sport following tibial plateau fractures: A systematic review

Return to sport following tibial plateau fractures: A systematic review

Complications in the management of closed high-energy proximal tibial plateau fractures

Treatment strategy for tibial plateau fractures: an update

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