J Korean Orthop Assoc.  2019 Jun;54(3):227-236. 10.4055/jkoa.2019.54.3.227.

Arthroscopically-Assisted Reduction and Internal Fixation of Intra-Articular Fractures of the Lateral Tibial Plateau

• Kim J
• Kim DH
• Lim JH
• Jang H
• Kim YW

• KMID: 2450142
• DOI: http://doi.org/10.4055/jkoa.2019.54.3.227

Abstract

PURPOSE
To evaluate the results of tibial lateral plateau fractures using arthroscopic-assisted reduction and internal fixation without cortical window or bone grafts.
MATERIALS AND METHODS
From March 2009 to March 2017, 27 patients with Schatzker type II tibial plateau fractures with articular depression and displacement over 5 mm on a computed tomography (CT) scan, who were treated with arthroscopic reduction and internal fixation and followed-up for at least 18 months, were enrolled in this study. Under arthroscopic guidance, the depressed fracture fragment was reduced using a freer and fixed with 5.0 or 6.5 mm cannulated screws through the inframeniscal portal without a cortical window or bone graft. The clinical and radiological results were evaluated using a Rasmussen system. Second look arthroscopy was performed in thirteen patients during the implant removal operation.
RESULTS
All fractures healed completely with a mean union time of 8.7 weeks (range from 8 to 12 weeks). Twenty four patients had good to excellent clinical results and 25 patients had good to excellent radiological results according to the Rasmussen classification. A well-healed articular surface with fibrocartilage was also found in 13 cases with second look arthroscopy. The 8 cases on CT scan at outpatient department follow-up showed bone union without bone grafting.
CONCLUSION
Arthroscopic-assisted fixation of tibial lateral plateau fractures is a useful method without a cortical window or bone graft that produces good clinical results.

Keyword

tibial lateral plateau fracture; arthroscopy; inframeniscal portal; freer elevator; bone graft

MeSH Terms

Arthroscopy
Bone Transplantation
Classification
Depression
Fibrocartilage
Follow-Up Studies
Humans
Intra-Articular Fractures*
Methods
Outpatients
Tomography, X-Ray Computed
Transplants

Figure

• 

  Figure 1. Fragment interfering with the reduction is called a key fragment (thick and short arrows). The landmark of the screw insertion site was the fibular head and Gerdy’s tubercle. The thin and long arrows indicate the direction of screw insertion.

• 

  Figure 2. Arthroscopic findings showed the depressed fracture fragment (A) and depressed fragment reduced using the freer (B). Three arthroscopic portals were used. The anteromedial portal was used for the viewing portal and 2 working (conventional anterolateral, anterolateral infra-meniscal portal) portals were used as the conventional anterolateral portal for inserting the skin hook to retract the anterior horn of lateral meniscus and anterolateral infra-meniscal portal was used to reduce the depressed fragment by the freer and small osteotome.

• 

  Figure 3. (A) Intraoperative fluoroscopic photograph shows a reduction of a tibia plateau fracture using a freer. (B) A guide wire was inserted for fixation of a 5.0 cannulated screw. (C, D) The 5.0 mm cannulated screw with a washer is fixed.

• 

  Figure 4. Second look arthroscopy by the anteromedial portal shows a healed articular surface with fibrocartilage.

• 

  Figure 5. A 47-year-old male with lateral plateau fracture. (A, B) Anteroposterior and lateral radiographs show a lateral tibial plateau fracture. (C, D) Preoperative computed tomography (CT) shows a Schatzker type II plateau fracture. (E, F) Arthroscopy by the anteromedial portal shows a depressed fracture fragment. (G) Arthroscopy-assisted reduction was done. (H) Lateral meniscal injury was found and repaired with absorbable sutures. (I, J) Internal fixation with 5.0 cannulated screws was done. (K, L) Postoperative CT shows an anatomically reduced articular surface.

Reference

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