Open Wedge Osteotomy of the Proximal Medial Tibia for Malunited Tibial Plateau Fractures

Singh, Harpreet; Singh, Vikas; Yuvarajan, P; Maini, Lalit; Gautam, VK

doi:10.1177/230949901101900113

Cited by 9 publications

(4 citation statements)

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“…Currently, revision methods for tibial plateau fracture malunion mainly include the following: 1) Extra-articular osteotomy to correct the alignment of the lower limb. Open medial tibial plateau osteotomy was used for the treatment of tibial plateau fracture varus deformity, and good results were achieved 9, 10. Because most of the tibial plateau fracture malunion consisted of intra-articular deformity, this application of the extra-articular osteotomy was limited.…”

Section: Discussionmentioning

confidence: 99%

Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment

Jiang

Zheng

Pan

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to evaluate our treatment algorithm and results in revision surgery of malunited tibial plateau fracture after failure of initial treatment.MethodsOur revision strategy was as follows: First, we determined the presence of any infection. Second, we determined whether the patient required total knee arthroplasty (TKA). Third, based on the characteristics of the tibial plateau fracture malunion, patients underwent one of the following surgical methods to achieve reduction: original fracture line osteotomy, tibial tubercle + original fracture line osteotomy, fibula head + original fracture line osteotomy, and metaphyseal open window reduction rod technique. The results was assessed with healing time, Rasmussen score, knee range of motion and complication rates.ResultsA total of 25 patients 16 men and 9 women; Mean age: 47.4 years (range: 35–63 years) underwent tibial plateau fracture revision operation. The time interval between the two surgeries was 2–24 months. The follow-up time was 12–30 months, and the operation time was 120–300 min. All patients received bone union at the last follow-up. The healing time was 3–6 months. The postoperative Rasmussen score was 19–29 (mean 23.8) compared with 14.4 points before the operation (p < 0.05). The postoperative knee joint activity was 60–110° (mean 95.0°), compared with 57.8° before the operation (p < 0.05). Six patients still had a 2-mm collapse on the articular surface, and 4 patients still had slight valgus (<5°). Except for 2 TKA cases, fracture reduction was excellent in 15 cases and good in 8 cases, with a good rate of 100%. Superficial wound infections occurred in 3 patients.ConclusionBecause revision of tibial plateau fracture malunion caused by failure of initial treatment is difficult, it is necessary to create a detailed surgical plan before the operation. Satisfactory clinical effects can be obtained if the correct revision strategy is used. The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion.Level of EvidenceLevel IV, Therapeutic Study.

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Section: Discussionmentioning

confidence: 99%

Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment

Jiang

Zheng

Pan

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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“…In combined malunions, several techniques can be combined, and treatment should be performed in two stages separated by 3-6 months to ensure consolidation (91). Table 4 shows a summary of the results from the literature on the treatment of malunions (94,96,97,98,99,100).…”

Section: Treatmentmentioning

confidence: 99%

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

2022

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Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis. The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA. Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection. In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage). Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.

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“…These problems were overcome by other authors who used OWOMTC. 17,18 This procedure is quite similar to tibial condylar valgus osteotomy (TCVO) described by Chiba et al for osteoarthritis of knee. 19 They differ only in the shape of the osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Open wedge osteotomy of medial tibial condyle gives good results in management of neglected diagonal lesions of proximal tibia

Mittal

Jain

Gamanagatti

2022

Journal of Clinical Orthopaedics and Trauma

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Open Wedge Osteotomy of the Proximal Medial Tibia for Malunited Tibial Plateau Fractures

Abstract: Open wedge osteotomy of the proximal medial tibia is recommended for young adults with instability of the knee joint secondary to malunited proximal tibial plateau fractures. The technique is simple and does not require specialised training or any specific instrumentation.

Cited by 9 publications

References 5 publications

Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment

Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

Open wedge osteotomy of medial tibial condyle gives good results in management of neglected diagonal lesions of proximal tibia

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