Surgical Strategy for Anterior Tibial Plateau Fractures in Hyperextension Knee Injuries

Liu, Zhongyu; Zhang, Jinli; Liu, Chang; Cao, Qian; Shen, Qijie; Zhao, Jing

doi:10.1111/os.12997

Cited by 12 publications

(19 citation statements)

References 24 publications

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“…According to the ROBINS-1 assessment tool 41 , 5 studies 16,23,25,26,40 were with a moderate risk of bias, 11 studies 6,17,19,24,27,28,30,31,36,37,39 were rated with a serious risk of bias, and 13 studies 2,7,8,18,20-22,29,32-35,38 were rated with a critical risk of bias (Appendices 1 and 2; http://links.lww.com/JBJSREV/A970). Twelve studies did not report the underlying diseases of the patients, which raises some concerns about adjusting confounding factors 2,6-8,17-22,24,27-39 . This was rated as raising some concerns.…”

Section: Resultsmentioning

confidence: 99%

Comparative Analysis of Posterior Approach Versus Anterior Approach for Posterior Tibial Plateau Fractures

Tsai

Lin

et al. 2023

JBJS Reviews

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Background: Posterior tibial plateau fractures can lead to significant posttraumatic instability if not treated properly. It remains unclear which surgical approach achieves better patient outcomes. The objective of this systematic review and meta-analysis was to assess postoperative outcomes in patients undergoing anterior, posterior, or combined approach for posterior tibial plateau fractures. Methods: The PubMed, Embase, Web of Science, The Cochrane Library, and Scopus were searched for studies published before October 26, 2022, comparing anterior, posterior, or combined approaches for posterior tibial plateau fractures. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Outcomes included complications, infections, range of motion (ROM), operation time, union rates, and functional scores. Significance was set at p < 0.05. Meta-analysis was conducted with STATA software. Results: In total, 29 studies with a total of 747 patients were included for quantitative and qualitative analysis. Compared with other approaches, the posterior approach for posterior tibial plateau fractures was associated with a better ROM and shorter operative time. The complication rates, infection rates, union time, and hospital for special surgery (HSS) scores were not significantly different between surgical approaches. Conclusions: The posterior approach for posterior tibial plateau fractures offers advantages such as improved ROM and shorter operative time. However, there are concerns regarding prone positioning in patients with medical or pulmonary comorbidities and indications in polytrauma cases. Further prospective studies are needed to determine the optimal approach for these fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

Comparative Analysis of Posterior Approach Versus Anterior Approach for Posterior Tibial Plateau Fractures

Tsai

Lin

et al. 2023

JBJS Reviews

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“…Depression fractures are common in the tibial plateau and are caused by high-energy trauma. The most frequent mechanism is the hyperextension of the knee which leads the femoral condyle to cause axial compression on the anterior tibial plateau [ 1 ]. But to date, no case of depressed fracture of the metadiaphysis of tibia without the involvement of the articular surface has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Depressed fractures of the tibial plateau are common and are caused by high-energy trauma [ 1 ]. The case we are presenting involves an unusual focal depression fracture of the proximal tibial metaphysis without any articular involvement and without any underlying bone pathology.…”

Section: Introductionmentioning

confidence: 99%

Report of a Rare Case of Focal Depressed Fracture of the Tibia in an Adult

Mahajan¹,

Kolleri²,

Prasad³

et al. 2022

Cureus

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Focal depressed fracture of the proximal tibial metaphysis without any articular involvement is a rare condition. We present a case of a 46-year-old man with a lacerated wound over the right proximal tibia after a history of slip and fall. The imaging involved to diagnose the condition included an X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) to exclude a pathological fracture and to better delineate the relationship between the fractured bone and the surrounding structures. Conservative management was indicated and implemented with a positive outcome.

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“…Hyperextension bicondylar tibial fracture is a speci c type of tibial plateau fracture with a low incidence of approximately 11% of all tibial plateau fractures [2]. The impact of hyperextension on the knee joint leads to fractures of the anterior rim of the tibia along with signi cant ligament injuries [3]. Currently, only a few studies have been conducted on hyperextension injury of the knee since it was rst reported in 1977 [4].…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of the hyperextension form of tibial plateau fractures involves reducing and xing the fractures and repairing ligament injuries, which restores the stability of the knee joint. However, there is no consensus on the ideal choice of surgical approach and fracture xation strategy [3], some authors have demonstrated and published a variety of options including a single midline incision or medial and lateral dual incisions to expose the fracture, anteriorly placed implants as well as medial and lateral dual plates to address the fracture [5,6,9]. Moreover, structural augments including tricortical iliac crest, bular allograft or spinal cage is recommended when the anterior metaphyseal void is greater than 1cm after restoring the posterior slope of the tibia [5].…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis and clinical efficacy of hyperextension bicondylar tibial plateau fractures fixed by medial and lateral dual plates and spinal cage

Huang

et al. 2023

Preprint

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Purpose To elucidate the biomechanical characteristics of fracture defect filled with spinal cage by finite element analysis, and investigate the clinical efficacy of medial and lateral dual plates with spinal cage for the treatment of hyperextension bicondylar tibial plateau fractures. Methods A 10-mm cuneiform defective osteotomy of proximal tibia was created in the finite element model to simulate hyperextension bicondylar tibial plateau fractures. The defect area in the established model was filled with spinal cage (Group A) or allograft bones (Group B) after fracture reduction. The biomechanical properties of both models were tested under axial compression loading and the maximum displacement of the fragments was recorded. Furthermore, a retrospective analysis was conducted on 12 patients with hyperextension bicondylar tibial plateau fractures who were surgically treated at the Lower Limb Surgery Ward of Traumatic Orthopedic Department, Xi’an Honghui Hospital from January 2020 to January 2022. The gender, age, cause of injury, associated injury, the preoperative and postoperative posterior tibial slope angle (pTSA), duration between injury and operation, surgical duration, intraoperative blood loss, complications, time of bone healing, time of weight bearing, Rasmussen radiological criteria and HSS scores were collected and analyzed. Results The finite element model showed that the maximum displacement in Group A was 0.1006 mm and that in Group B was 0.1203 mm, whereas the maximum stress in the two groups were 39.70 MPa and 43.69 MPa respectively. Therefore, implantation of spinal cage into the bone defect area after fracture reduction has obvious biomechanical advantages. We also analyzed 12 patients (9 males and 3 females, aged ranging from 27 to 66 years with mean age of 46.0 ± 12.3 years) with Schatzker type VI fractures. The patients were successfully followed up for an average of 12.50 ± 3.37 months (8 to 18 months). The postoperative pTSA was significantly improved related to the preoperative pTSA (P < 0.001). The average duration between injury and operation was 6.08 ± 2.78 days, the average surgical duration was 131.67 ± 32.71 min, and the average intraoperative blood loss was 320.83 ± 113.73ml. Furthermore, the average time of bone healing was 13.58 ± 2.57 weeks and the average time of weight-bearing was 8.33 ± 2.93 weeks. In addition, 33.33% of postoperative complications was observed in 1 case of superficial wound infection and dehiscence, 1 case of delayed union combined with limited range of motion of the knee joint and 2 cases of deep vein thrombosis. The excellent and good rates of Rasmussen radiological criteria and HSS scores were 83.33% and 91.67% respectively. Conclusion Fracture reduction and fixation by medial and lateral dual plates and spinal cage is an effective method for the treatment of hyperextension bicondylar tibial plateau fractures, and has biomechanical advantages such as favorable bone healing time, weight bearing time, radiographic and clinical functional outcomes.

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Surgical Strategy for Anterior Tibial Plateau Fractures in Hyperextension Knee Injuries

Cited by 12 publications

References 24 publications

Comparative Analysis of Posterior Approach Versus Anterior Approach for Posterior Tibial Plateau Fractures

Comparative Analysis of Posterior Approach Versus Anterior Approach for Posterior Tibial Plateau Fractures

Report of a Rare Case of Focal Depressed Fracture of the Tibia in an Adult

Finite element analysis and clinical efficacy of hyperextension bicondylar tibial plateau fractures fixed by medial and lateral dual plates and spinal cage

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