Partial proximal tibia fractures

Abstract

Partial tibial plateau fractures may occur as a consequence of either valgus or varus trauma combined with a rotational and axial compression component.High-energy trauma may result in a more complex and multi-fragmented fracture pattern, which occurs predominantly in young people. Conversely, a low-energy mechanism may lead to a pure depression fracture in the older population with weaker bone density.Pre-operative classification of these fractures, by Müller AO, Schatzker or novel CT-based methods, helps to understand the fracture pattern and choose the surgical approach and treatment strategy in accordance with estimated bone mineral density and the individual history of each patient.Non-operative treatment may be considered for non-displaced intra-articular fractures of the lateral tibial condyle. Intra-articular joint displacement ⩾ 2 mm, open fractures or fractures of the medial condyle should be reduced and fixed operatively. Autologous, allogenic and synthetic bone substitutes can be used to fill bone defects.A variety of minimally invasive approaches, temporary osteotomies and novel techniques (e.g. arthroscopically assisted reduction or ‘jail-type’ screw osteosynthesis) offer a range of choices for the individual and are potentially less invasive treatments.Rehabilitation protocols should be carefully planned according to the degree of stability achieved by internal fixation, bone mineral density and other patient-specific factors (age, compliance, mobility). To avoid stiffness, early functional mobilisation plays a major role in rehabilitation. In the elderly, low-energy trauma and impression fractures are indicators for the further screening and treatment of osteoporosis.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160067. Originally published online at www.efortopenreviews.org

Tibiakopffraktur – Klassifikation und spezifische Zugänge

“…Die Indikation zur operativen Versorgung einer Tibiakopffraktur besteht, sofern mindestens eines der folgenden Kriterien vorliegt [20] (s. Übersicht).…”

Comparison of X-Ray Imaging and Computed Tomography Scan in the Evaluation of Knee Trauma

“…For example, in proximal tibial fractures, the fractures extending to the joint space longer than 2 mm, open fractures, and the medial condyle fractures should be fixed under surgery. In contrast, the lateral condyle fractures and the fractures not extending to the joint space can be treated non-operatively [24]. In a study investigating fracture characteristics, the highest sensitivity of XR imaging in determining the fracture type was found in linear fractures (55%).…”

Chirurgische Zugänge zum Tibiakopf

“…Zur Indikationsprüfung der operativen Versorgung einer Tibiakopffraktur sollten folgende Fragen gestellt werden [14,15] Bei der Planung der Operation sollte neben dem Allgemeinzustand des Patienten und weiteren Begleitverletzungen auch der Weichteilschaden am frakturierten Tibiakopf berücksichtigt werden. Bei stark geschwollenen Weichteilen sollte die definitive Versorgung verzögert und erst nach adäquatem Abschwellen idealerweise nach 5-8 Tagen stattfinden.…”

“…Hier sollte berücksichtigt werden, dass insbesondere posterolaterale Frakturfragmente nicht ausreichend durch anterolateral eingebrachtes Osteosynthesematerial gefasst werden können [20,21]. Daher sollten Fragmente im posterolaterozentralen Segment und posteromedialen Quadranten auch bevorzugt direkt über dorsale Zugänge versorgt werden [22 -24] [14]; blau posteriorer posteromedialer Zugang [11,15,16]; bordeaux anterolateraler Zugang [14]; orange modifizierter posterolateraler Zugang [16]; rot erweiterter lateraler Zugang [17]; gelb erweiterter medialer Zugang [18] (ALL: anterolaterolateral, ALZ: anterolaterozentral, AZ: anterozentral, AMZ: anteromediozentral, AMM: anteromediomedial, PLL: posterolaterolateral, PLZ: posterolaterozentral, PZ: posterozentral, PMZ: posteromediozentral, PMM: posteromediomedial).…”