medigraphic.com
ISSN 2007-8560 (Print)
Órgano Oficial de Difusión Científica de la Federación Mexicana de Colegios de Ortopedia y Traumatología, A.C. (FEMECOT)

2024, Number 1

<< Back Next >>

Ortho-tips 2024; 20 (1)

Posterior direct fixation in conjunction with anterolateral or medial fixation vs indirect fixation for posterior tibial plateau fractures

Flores AMA, Valdivia ZCA, Cámara AFE, Martínez EFA, Balam MÁJ, Bobadilla LG

Language: Spanish
References: 20
Page: 22-28
PDF size: 269.63 Kb.


ABSTRACT

Introduction: there is controversy about the need to perform direct fixation in posterior column tibial plateau fractures. Objective: the purpose of this study is to determine if there is radiographic difference in the magnitude of displacement when direct fixation is compared with indirect fixation of the posterior column. Material and methods: all patients with tibial plateau fractures (41B1-3, and 41C1-3 AO classification) affecting the posterior column who underwent surgical treatment between January 2017 and January 2022 were evaluated, forming two groups to be compared according to the fixation method used. One group was treated with direct fixation of the posterior column through a posterior approach and a posterior locked plate. The second group was treated with indirect posterior column fixation through anterolateral approach and a lateral locked plate. According to the requirements of each fracture pattern, a lateral or medial plate fixation was also performed. Results: posterior fixation showed minimal displacement in the coronal plane during a mean follow-up of six months with an increase of 0.6° (p = 0.27), showing a collapse of 0.76° (p < 0.05) in the sagittal plane. Anterolateral indirect fixation showed displacement with collapse in the coronal plane of 2.14° (p < 0.05), and a collapse of 3.38° (p < 0.05) in the sagittal plane. Conclusions: posterior direct fixation offers greater stability with less displacement in the coronal and sagittal plane compared to anterolateral indirect fixation.


REFERENCES

  1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006; 37 (8): 691-697. doi: 10.1016/j.injury.2006.04.130.

  2. Elsoe R, Larsen P, Nielsen NPH, Swenne J, Rasmussen S, Ostgaard SE. Population-based epidemiology of tibial plateau fractures. Orthopedics. 2015; 38 (9): e780-786. doi: 10.3928/01477447-20150902-55.

  3. Lovato SF. Prevalencia de fracturas de cadera, fémur y rodilla en la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes", del Instituto Mexicano del Seguro Social. Acta Ortop Mex. 2015; 29 (1): 13-20.

  4. Yang G, Zhai Q, Zhu Y, Sun H, Putnis S, Luo C. The incidence of posterior tibial plateau fracture: An investigation of 525 fractures by using a CT-based classification system. Arch Orthop Trauma Surg. 2013; 133 (7): 929-934. doi: 10.1007/s00402-013-1735-4.

  5. Kottmeier SA, Watson JT, Row E, Jones CB. Staged fixation of tibial plateau fractures: strategies for the posterior approach. J Knee Surg. 2016; 29 (1): 2-11. doi: 10.1055/s-0035-1564728.

  6. Higgins TF, Kemper D, Klatt J. Incidence and morphology of the posteromedial fragment in bicondylar tibial plateau fractures. J Orthop Trauma. 2009; 23 (1): 45-51. doi: 10.1097/BOT.0b013e31818f8dc1.

  7. Hohl M. Tibial condylar fractures. 1967; 49 (7): 1455-1467. Available in: https://journals.lww.com/jbjsjournal/Abstract/1967/49070/Tibial_Condylar_Fractures.22.aspx

  8. Zeng ZM, Luo CF, Putnis S, Zeng BF. Biomechanical analysis of posteromedial tibial plateau split fracture fixation. Knee. 2011; 18 (1): 51-54. Available in: http://dx.doi.org/10.1016/j.knee.2010.01.006

  9. Thewlis D, Callary SA, Fraysse F, Solomon LB. Peak loading during walking is not associated with fracture migration following tibial plateau fracture: a preliminary case series. J Orthop Res. 2015; 33 (9): 1398-1406. doi: 10.1002/jor.22905

  10. Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010; 24 (11): 683-692. doi: 10.1097/BOT.0b013e3181d436f3.

  11. Zhu Y, Yang G, Luo CF, Smith WR, Hu CF, Gao H, et al. Computed tomography-based Three-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility. J Trauma Acute Care Surg. 2012; 73 (3): 731-737. doi: 10.1097/TA.0b013e31825c17e7.

  12. Galla M, Lobenhoffer P. Der direkte dorsale zugangsweg zur versorgung posteromedialer luxationsfrakturen des tibiakopfes. Unfallchirurg. 2003; 106 (3): 241-247. doi: 10.1007/s00113-002-0554-9.

  13. Lin KC, Tarng YW, Lin GY, Yang SW, Hsu CJ, Renn JH. Prone and direct posterior approach for management of posterior column tibial plateau fractures. Orthopaedics and traumatology: surgery and Research. 2015; 101 (4): 477-482. doi: 10.1016/j.otsr.2014.12.021.

  14. Hong G, Huang X, Lv T, Li X. An analysis on the effect of the three-incision combined approach for complex fracture of tibial plateau involving the posterolateral tibial plateau. J Orthop Surg Res. 2020; 15 (1): 1-10. doi: 10.1186/s13018-020-1572-4.

  15. Elsoe R, Johansen MB, Larsen P. Tibial plateau fractures are associated with a long-lasting increased risk of total knee arthroplasty a matched cohort study of 7,950 tibial plateau fractures. Osteoarthritis Cartilage. 2019; 27 (5): 805-809. doi: 10.1016/j.joca.2018.12.020.

  16. Lucht U, Pilgaard S. Fractures of the tibial condyles. Acta Orthop Scand. 1971; 42 (4): 366-376. doi: 10.3109/17453677108989057. Available in: http://www.tandfonline.com/doi/full/10.3109/17453677108989057

  17. Jensen D, Rude C, Duus B, Bjerg-Nielsen A. Tibial plateau fractures. A comparison of conservative and surgical treatment. J Bone Joint Surg Br. 1990; 72-B (1): 49-52. Available in: https://online.boneandjoint.org.uk/doi/10.1302/0301-620X.72B1.2298794

  18. Singleton N, Sahakian V, Muir D. Outcome after tibial plateau fracture: how important is restoration of articular congruity? J Orthop Trauma. 2017; 31 (3): 158-163. doi: 10.1097/BOT.0000000000000762.

  19. Sinha S, Singh M, Saraf SK, Rastogi A, Rai AK, Singh TB. Fixation of posterior tibial plateau fracture with additional posterior plating improves early rehabilitation and patient satisfaction. Indian J Orthop. 2019; 53 (3): 472-478. doi: 10.4103/ortho.IJOrtho_295_18. Available in: https://link.springer.com/10.4103/ortho.IJOrtho_295_18

  20. Robledo-Herrera O, Diego-Ball D, Oliva-Ramírez S. Abordaje posteromedial y colocación de placa en fractura de meseta tibial con fragmento posterior. Acta Ortop Mex. 2015; 29 (2): 69-76.



EVIDENCE LEVEL

III, casos y controles.




2020     |     www.medigraphic.com