THE INFLUENCE OF THE OSTEOSYNTHESIS METHODS ON THERAPEUTIC MANAGEMENT OF THE PATIENTS WITH TIBIAL PLATEAU FRACTURES

  • N. FORNA “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Cristina DASCALU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • P.D. SIRBU “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

Aim: The aim of study was to assess the influence of the osteosynthesis methods on the therapeutic management of the patients with tibial plateau fractures. Material and methods: The retrospective study was conducted on 63 patients (mean age 59.5 years; 37 males, 26 females) with tibial plateau fractures treated in Orthopedic Clinic - Traumatology Clinic Aschaffenburg-Alzenau (Germany) in the period 2015-2016. The mean values of pre-operatory interval, hospitalization time, surgical procedure duration, ablation time were calculated for each osteosynthesis method. Mann-Whitney tests were used for statistical comparisons between the implants systems in relation to the assessed parameters. Statistical significance was set up for p<0.05. Results: The pre-operative time was the highest for patients treated with rotating hinge (5.1 days), followed by plates + screws + Kirschner wires (4.0 days). The length of hospitalization was the highest for patients treated with rotating hinge (18.8 days), followed by plates (12.88 days). The duration of the surgical intervention was the highest for patients treated with plates + screws + Kirschner wires (95.0 minutes), followed by plates + screws (84.29 minutes). The ablation interval was the highest for patients treated with plates (12 days). Length of hospitalization was significantly higher (p<0.05) for patients treated with rotating hinge vs. alternative implants systems. Conclusions: It is very important to correlate the parameters related to the patients’ management with implants and other relevant factors (systemic status, surgeon experience, soft tissues status, osteoporosis) to optimize the decision- making process and the long-term results of the treatment of the tibial plateau fractures.

Author Biographies

N. FORNA, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Surgery (II)

Cristina DASCALU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Preventive Medicine and Interdisciplinarity

P.D. SIRBU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Surgery (II)

References

1. Momaya AM, Hlavacek J, Etier B, et al. Risk factors for infection after operative fixation of tibial plateau fractures. Injury 2016; 47(7): 1501-1505.
2. Vendeuvre T, Gaye LE, Percutaneous treatment of tibial plateau fractures. Orthopaedics & Trauma-tology: Surgery & Research 2021; 107(1): 102753 / doi: 10.1016/j.otsr.2020.102753.
3. Antonescu MD. Ortopedie-Traumatologie, Volume 2: Bucuresti: Editura Academiei Romane, 2012.
4. Maniar H, Kubiak EN, Horwitz DS, editors. Rockwood and Green’s Fractures in Adults. 9th edition Philadelphia: Wolters Kluwer: 2019, 4231-4324.
5. Hall JA, Beuerlein MJ, McKee M. Canadian Orthopedic Trauma Society. Open Reduction and Internal Fixation Compared with Circular Fixator Application for Bicondylar Tibial Plateau Fractures. J Bone Jt Surg 2009; 91: 74-88.
6. Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev 2016; 1: 225-232.
7. Li K, Zhang S, Qiu X, et al. Optimal surgical timing and approach for tibial plateau fracture. Technol Health Care 2022; 30(S1): 545-551.
8. Xu YQ, Li Q, Shen TG, Su PH, Zhu YZ. An efficacy analysis of surgical timing and procedures for high-energy complex tibial plateau fractures. Orthop Surg. 2013; 5(3): 188-195.
9. Zhao G, He Q, Duan H, Ma J. Treatment of posterolateral tibial plateau fractures through fibular osteotomy approach. Acta Orthop Belg 2019; 85(1): 114-121.
10. Sun H, Zhu Y, He QF, Shu LY, Zhang W, Chai YM. Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau: The magic screw technique. Injury. 2017; 48(12): 2814-2826.
11. Sun H, He QF, Zhang BB, Zhu Y, Zhang W, Chai YM. A biomechanical evaluation of different fixation strategies for posterolateral fragments in tibial plateau fractures and introduction of the “magic screw”. Knee 2018; 25(3): 417-426.
12. Weaver MJ, Harris MB, Strom AC, et al. Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures. Injury 2012; 43: 864-869.
13. Barei DP, O’Mara TJ, Taitsman LA, Dunbar RP, Nork SE. Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma 2008; 22: 176-182.
14. Shen QJ, Zhang JL, Xing GS, et al. Surgical Treatment of Lateral Tibial Plateau Fractures Involving the Posterolateral Column. Orthop Surg 2019; 11(6): 1029-1038.
15. Mao W, Chen G, Zhu Y, et al. Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach. Medicine (Baltimore) 2021; 100(38): e27316 / doi: 10.1097/MD.0000000000027316.
16. Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 2010; 24: 683-692.
17. Ehlinger M, Rahme M, Moor BK, et al. Reliability of locked plating in tibial plateau fractures with a medial component. Orthop Traumatol Surg Res 2012; 98(2): 173-179.
18. Nikolaou VS, Tan HB, Haidukewych G, Kanakaris N, Giannoudis PV. Proximal tibial fractures: early experience using polyaxially locking-plate technology. Int Orthop 2011; 35(8): 1215-1221.
19. 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): 1178-1782.
Published
2022-06-30