J Korean Fract Soc.  2013 Jul;26(3):191-198. 10.12671/jkfs.2013.26.3.191.

Arthroscopic Assisted Intra-Articular Reduction and Internal Fixation of Tibia Plateau Fracture

• Kim DH
• Lee GC
• Choi KY
• Cho SW
• Ha SH

• KMID: 1431663
• DOI: http://doi.org/10.12671/jkfs.2013.26.3.191

Abstract

PURPOSE
We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts.
MATERIALS AND METHODS
From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system.
RESULTS
The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases.
CONCLUSION
We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.

Keyword

Knee joint; Tibial fracture; Arthroscopy

MeSH Terms

Arthroscopy
Depression
Displacement (Psychology)
Humans
Knee Joint
Tibia
Tibial Fractures
Transplants

Figure

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  Fig. 1 A fragment interfering with the reduction is called a key fragment (short arrows). The landmark of the screw insertion site was fibular head and Gerdy's tubercle. Long arrows indicate direction of screw insertion.

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  Fig. 2 Arthroscopic findings See the depressed fracture fragment (A) and depressed fragment reduced by freer (B).

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  Fig. 3 Preoperative radiologic findings. Antero-posterior (AP) view (A) and computed tomography images (B) of the right knee of a 28-year-old male patient shows a depressed lateral tibial plateau fracture (Schatzker type II). Both AP and lateral view (C, D) of the right knee shows a complete fracture reduction and internal fixation using a cannulated screw without bone graft.

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  Fig. 4 Preoperative radiologic findings. Antero-posterior (AP) view (A) and computed tomography (CT) image (B) of the left knee of a 60-year-old male patient shows a tibia plateau fracture (Schatzker type V). Postoperative radiographic findings. AP view (C) and CT image (D) of the left knee shows an additional fixation by locking compression plate-proximal lateral tibia minimally invasive plate osteosynthesis (LCP-PLT) (MIPO technique).

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  Fig. 5 (A) Ten months after the operation, computed tomography images show a complete bone union with congruency of the articular surface. (B) Second look arthroscopy shows a healed articular surface as well as lateral meniscus.

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