Closed Reduction and Percutaneous Screws Fixation in Tibial Plateau Fractures

Abdelkareem, Omar M; Shiha, Anis Alsaut; Elazab, Hussam Eldin M; Ali, Mohamed

doi:10.21608/smj.2018.41657

Closed Reduction and Percutaneous Screws Fixation in Tibial Plateau Fractures

Document Type : Original Article

Authors

Department of orthopedics and traumatology, Sohag University, Egypt.

10.21608/smj.2018.41657

Abstract

Purpose:To evaluate treatment outcomes of closedreduction and percutaneous screw fixation for tibialplateau fractures.
Methods:18 men and 4 women aged 21 to 64 (mean, 38.1) years underwent closed reduction and percutaneous screw fixation for closed tibial plateaufractures. According to theSchatzker classification, patients were classifiedinto type I (n=6), type III (n=10), type IV (n=4), andtype V (n=2). Closed reduction was achieved usingmanual ligamentotaxis with traction in extensionunder image intensifier control. Reduction was fixedpercutaneously with cancellous screws (6.5 mm) andwashers. Functional outcome (pain, walking capacity,extension lag, range of motion, stability and return to daily activity) wasevaluated using the Modified Hospital for Special Surgery Score. A total score of 55 to 60 was considered as excellent, 45 to 54 as good, 35 to 44 as fair, and Results:Patients were followed up for a mean of 8 (range, 6–12) months. The mean length of hospitalstay was 2 (range, 1–3) days. All the fracture unitedradiographically after a mean of 3 (range, 2.5–3.5)months. Respectively in Schatzker types-I, -III, -IV, and-V fractures, outcomes were excellent in 4, 1, 1, and 0 patients, good in 2, 6, 2, and 0 patients, fair in 0, 3, 0, and 1 patients, and poor in 0, 0, 1, and 1 patients.
Outcome was satisfactory (good-to-excellent) in 100%, 70%, 75%, and 0% of the respective fracture typesof patients. The mean Modified-HSS score was 46.2 for all patients; it was 53.3 for type I, 40.3 for typeIII, 45 for type IV, and 36 for type V fractures. One patient had metal failure due to early weight bearing at 5 weeks. No patient had infection or wound dehiscence.
Conclusion:Closed reduction and percutaneous screw fixation for tibial plateau fractures is minimally invasive. It reduces the length of hospitalstay and costs, enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes.

References

Hohl M. Articular fractures of the proximal tibial. In: Evarts CM, editor. Surgery of the musculoskeletal system. New York: Churchill-Livingstone; 1993:3471–97.
Schatzker J. Fracture of the tibial plateau. In: Schatzker J, Tile M, editors. The rationale of operative fracture care. Berlin: Springer-Verlag; 1987:279–95.
Stevens DG, Beharry R, McKee MD, Waddall JP, Schemitsch EH. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 2001;15:312–20.
Sangwan SS, Siwach RC, Singh R, Mittal R. Minimal invasive osteosynthesis: a biological approach in treatment of tibial plateau fractures. Indian J Orthop 2002;36:246–50.
Shete K, Sancheti P, Kamdar R. Role of Esmarch bandage and percuteneous cannulated cancellous screws in tibial condylar fracture. Indian J Orthop 2006;40:173–6.
Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002;84:1541–51.
De Mourgues G, Chaix D. Treatment of fracture of the tibial plateau [in French]. Rev Chir Orthop Reparatrice Appar Mot 1964;50:103–22.
Apley AG. Fractures of the tibial plateau. Orthop Clin North Am 1979;10:61–74.
Mathur H, Acharya S, Nijhawan VK, Mandal SP. Operative results of closed tibial plateau fractures. Indian J Orthop 2005;39:108–12.
Lobenhoffer P, Schulze M, Gerich T, Lattermann C, Tscherne H. Closed reduction/percutaneous fixation of tibial plateau fractures: arthroscopic versus fluoroscopic control of reduction. J Orthop Trauma 1999;13:426–31.
Mast J, Jakob R, Ganz R. Reduction with distraction. In: Mast J, Jakob R, Ganz R, editors. Planning and reduction technique in fracture surgery. Berlin: Springer-Verlag; 1989:130–42.
Koval KJ, Sanders R, Borrelli J, Helfet D, DiPasquale T, Mast JW. Indirect reduction and percutaneous screw fixation of displaced tibial plateau fractures. J Orthop Trauma 1992;6:340–6.
Keogh P, Kelly C, Cashman WF, McGuinness AJ, O’Rourke SK. Percutaneous screw fixation of tibial plateau fractures. Injury 1992;23:387–9.