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Journals / Acta Orthopaedica et Traumatologica Turcica / 2019 / Cilt: 53 - Sayı: 6

Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment

Jiang LİANGJUN
Zheng QİANG
Pan ZHİJUN
Hang Lİ
Pages
432–441
DOI
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Objective: The aim of this study was to evaluate our treatment algorithm and results in revision surgery of malunited tibial plateau fracture after failure of initial treatment.
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Key Findings & Data:Methods: Our revision strategy was as follows: First, we determined the presence of any infection.
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Conclusion & Impact:The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Domain Parameters

Özet

Objective: The aim of this study was to evaluate our treatment algorithm and results in revision surgery of malunited tibial plateau fracture after failure of initial treatment. Methods: Our revision strategy was as follows: First, we determined the presence of any infection. Second, we determined whether the patient required total knee arthroplasty (TKA). Third, based on the characteristics of the tibial plateau fracture malunion, patients underwent one of the following surgical methods to achieve reduction: original fracture line osteotomy, tibial tubercle þ original fracture line osteotomy, fibula head þ original fracture line osteotomy, and metaphyseal open window reduction rod technique. The results was assessed with healing time, Rasmussen score, knee range of motion and complication rates. Results: A total of 25 patients 16 men and 9 women; Mean age: 47.4 years (range: 35e63 years) underwent tibial plateau fracture revision operation. The time interval between the two surgeries was 2e24 months. The follow-up time was 12e30 months, and the operation time was 120e300 min. All patients received bone union at the last follow-up. The healing time was 3e6 months. The postoperative Rasmussen score was 19e29 (mean 23.8) compared with 14.4 points before the operation (p < 0.05). The postoperative knee joint activity was 60e110 (mean 95.0), compared with 57.8 before the operation (p < 0.05). Six patients still had a 2-mm collapse on the articular surface, and 4 patients still had slight valgus (<5). Except for 2 TKA cases, fracture reduction was excellent in 15 cases and good in 8 cases, with a good rate of 100%. Superficial wound infections occurred in 3 patients. Conclusion: Because revision of tibial plateau fracture malunion caused by failure of initial treatment is difficult, it is necessary to create a detailed surgical plan before the operation. Satisfactory clinical effects can be obtained if the correct revision strategy is used. The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion.

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Cite This Article

LİANGJUN, J., QİANG, Z., ZHİJUN, P., Lİ, H. (2019). Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment. Acta Orthopaedica et Traumatologica Turcica, Cilt: 53 - Sayı: 6, 432–441. https://ajindex.com/articles/147387

References (15)

  1. Urruela AM, Davidovitch R, Karia R, Khurana S, Egol KA. Results following operative treatment of tibial plateau fractures. J Knee Surg. 2013;26(3):161e165
  2. Kugelman D, Qatu A, Haglin J, Leucht P, Konda S, Egol K. Complications and unplanned outcomes following operative treatment of tibial plateau fractures. Injury. 2017;48(10):2221e2229
  3. Mahadeva D, Costa ML, Gaffey A. Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature. Arch Orthop Trauma Surg. 2008;128(10):1169e1175
  4. Bennett WF, Browner B. Tibial plateau fractures: a study of associated soft tissue injuries. J Orthop Trauma. 1994;8(3):183e188
  5. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am. 1973;55(7): 1331e1350
  6. Scott CE, Davidson E, MacDonald DJ, White TO, Keating JF. Total knee arthroplasty following tibial plateau fracture: a matched cohort study. Bone Joint J. 2015;97-B(4):532e538
  7. Xu YF, Luo CF. Progress in revision of malunion of tibial plateau fractures. Int J Ortho. 2015;36(1):40e44
  8. Biggi F, Di Fabio S, D'Antimo C, Trevisani S. Tibial plateau fractures: internal fixation with locking plates and the MIPO technique. Injury. 2010;41(11): 1178e1182
  9. Sundararajan SR, Nagaraja HS, Rajasekaran S. Medial open wedge high tibial osteotomy for varus malunited tibial plateau fractures. Arthroscopy. 2017;33(3):586e594
  10. Singh H, Singh VR, Yuvarajan P, Maini L, Gautam VK. Open wedge osteotomy of the proximal medial tibia for malunited tibial plateau fractures. J Orthop Surg (Hong Kong). 2011;19(1):57e59
  11. Moyad TF, Estok D. Simultaneous femoral and tibial osteotomies during total knee arthroplasty for severe extra-articular deformity. J Knee Surg. 2009;22(1): 21e26
  12. Xiao-Gang Z, Shahzad K, Li C. One-stage total knee arthroplasty for patients with osteoarthritis of the knee and extra-articular deformity. Int Orthop. 2012;36(12):2457e2463
  13. Papagelopoulos PJ, Karachalios T, Themistocleous GS, Papadopoulos E, Savvidou OD, Rand JA. Total knee arthroplasty in patients with preexisting fracture deformity. Orthopedics. 2007;30(5):373e378
  14. Wang Y, Luo C, Hu C, Sun H, Zhan Y. An innovative intra-articular osteotomy in the treatment of posterolateral tibial plateau fracture malunion. J Knee Surg. 2017;30(4):329e335
  15. Burki H, von Knock M, Heiss C, Drobny T, Munzinger U. Lateral approach wit