Tibial plateau fractures: compared outcomes between ARIF and ORIF

Abstract

The purpose of this study is to compare arthroscopic assisted reduction internal fixation (ARIF) treatment with open reduction internal fixation (ORIF) treatment in patients with tibial plateau fractures. We studied 100 patients with tibial plateau fractures (54 men and 46 women) examined by X-rays and CT scans, divided into 2 groups. Group A with associated meniscus tear was treated by ARIF technique, while in group B ORIF technique was used. The follow-up period ranged from 12 to 116 months. The patients were evaluated both clinically and radiologically according to the Rasmussen and HSS (The Hospital for Special Surgery knee-rating) scores. In group A, the average Rasmussen clinical score is 27.62 ± 2.60 (range, 19–30), while in group B is 26.81 ± 2.65 (range, 21–30). HSS score in group A was 76.36 ± 14.19 (range, 38–91) as the average clinical result, while in group B was 73.12 ± 14.55 (range, 45–91). According to Rasmussen radiological results, the average score for group A was 16.56 ± 2.66 (range, 8–18), while in group B was 15.88 ± 2.71 (range, 10–18). Sixty-nine of 100 patients in our study had associated intra-articular lesions. We had 5 early complications and 36 late complications. The study suggests that there are no differences between ARIF and ORIF treatment in Schatzker type I fractures. ARIF technique may increase the clinical outcome in Schatzker type II–III–IV fractures. In Schatzker type V and VI fractures, ARIF and ORIF techniques have both poor medium- and long-term results but ARIF treatment, when indicated, is the best choice for the lower rate of infections.

Arthroscopically Assisted Fixation of the Tibial Plateau Fractures

“…Despite the small amount of studies comparing ARIF with ORIF technique [26,45,51] and studies with an average follow up longer than 3 years) [5,8,26,34,36,[38][39][40]43,44,47,49,[52][53][54]56], the advocates of ARIF suggest, that this technique can have a key role in the management of tibial plateau fractures and is the treatment of choice for associated intra-articular pathology.…”

“…Most of the studies ( Figure 3) were focused on arthroscopically assisted internal fixation of tibial plateau fractures, while there was one about arthroscopically assisted external ring fixation of tibial plateau fractures [27] and another about both techniques depending on fracture type [44]. There were only three comparative studies [26,45,51] between these two techniques.…”

“…Arthroscopy allows direct visualization of the soft tissue and articular surface damages [23][24][25] and, therefore, precise reduction of fracture fragments. Lately, arthroscopically assisted circular external fixation in bicondylar tibial plateau fractures has been introduced [26,27]. This technique is ideally used for Schatzker V and VI fractures to reduce the possibility of infection and soft tissue problems that occur by using two side plates [27].…”

“…They evaluated the Rasmussen score, the HSS (The Hospital for Special Surgery knee-rating) score and complications (Table 4). They suggested, that there are no differences between ARIF and ORIF treatment in Schatzker type I fractures, ARIF technique may increase the clinical outcome in Schatzker type II-III-IV fractures and that in Schatzker type V and VI fractures, ARIF and ORIF techniques have both poor medium-and long-term results but ARIF treatment, when indicated, is the best choice due to the lower rate of infections [26].…”

Arthroscopy Assisted Reduction Percutaneous Internal Fixation versus Open Reduction Internal Fixation for Low Energy Tibia Plateau Fractures

“…Arthroscopy assisted reduction percutaneous internal fixation (ARIF) is emerging recently as an alternative treatment method in treating lower energy tibia plateau fractures 14–18 . The main advantage of this method relied on the minimally invasive nature during operation without violating the structures aforementioned 14,15,17,18 . There is controversy over the effectiveness of the two treatment methods, ORIF and ARIF concerning treatment of lower energy tibia plateau fractures.…”