Management of tibial plateau fractures schatzker type v and vi with compromised soft tissue with minimal internal and external fixation
|IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:78
Conference: Indian Orthopaedic Association Annual Conference IOACON-2013, India [Click for Full details]
Authors: Patil Y
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Background: High energy tibial plateau fractures are usually associated with communition and severe soft tissue injury. Percutaneous treatment of these complex fractures is intended to reduce soft issue complications and postoperative stiffness of the knee joint. We assessed the complications, clinical outcome scores, and postoperative knee range of movements, after fluoroscopic assisted closed reduction,minimal internal fixation and external fixator application.
Materials and Methods: Tibial plateau fractures in 35 patients with Schatzker’s Type V and VI were included in the study. 27 males and 8 were females, mean age 34.5 years All fractures were managed with closed reduction, external fixator application and minimal internal fixation with percutaneous 6.5 mm cancellous screws with or without washers for reduction and fixation of condylar parts under fluoroscopy. The screws were applied perpendicular to the plane of the fracture, in the subchondral bone just below the articular surface. In special situations, intraarticular reduction was achieved with the help of tenaculum applied externally One Steinmann pin (4 mm) was passed through and through the tibial condyle just below the screw. In the distal fragment one Schanz screw and one Steinmann pin (4 mm) hammered (through and through) after predrilling with 3.2 mm drill bit. If required additional cancellous screws were used for good intercondylar reduction. In nineteen open fractures, immediate debridement was done. In 16 cases, elevation of depressed segment was required, which was done from a very small incision with the help of bone lever/curved artery. All patients were clinically and radiographically evaluated at a mean followup of 13.5 months (range 6–24months).
Results: Clinical results were evaluated according to the Rasmussen’s criteria. Average healing time was 14 weeks (range 12– 28 weeks). Mean knee range of motion was 110.° (range 90°–130°). 19 results were scored as excellent, 13 good, 2 fair and 1 as poor. There was superficial pin tract infection in 4 cases which resolved with pin tract care and oral antibiotics. In 5 cases, varus malunion mean 12° (range 10°–20°) occurred due to loss of reduction/alignment in fixator, in one case 70 valgus malunion occured. However, functionally, the knee ROM was unaffected.
Conclusion: Minimal internal and external fixation for management of tibial plateau fracture with compromised soft tissue is more biological, require less surgical time, hospital stay, is cost effective and have minimum complications with good functional outcome. Minimally invasive treatment by percutaneous techniques and external fixation is a fairly reasonable treatment alternative.
|How to Cite this Abstract|
|Patil Y . Management of tibial plateau fractures schatzker type v and vi with compromised soft tissue with minimal internal and external fixation. International Journal of Conference Proceedings 2015;(2015):78|