Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up
Abstract Background To investigate the radiologic and prognostic outcomes after using arthroscopic-assisted reduction and internal fixation (ARIF) in complex tibial plateau fractures with mid- to long-term follow-up. Methods This retrospective study reviewed complex tibial plateau fractures that und...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-023-03938-8 |
| _version_ | 1797795574870704128 |
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| author | You-Hung Cheng Cheng-Pang Yang Shih-Sheng Chang Chun-Jui Weng Chih-Hao Chiu Yi-Sheng Chan |
| author_facet | You-Hung Cheng Cheng-Pang Yang Shih-Sheng Chang Chun-Jui Weng Chih-Hao Chiu Yi-Sheng Chan |
| author_sort | You-Hung Cheng |
| collection | DOAJ |
| description | Abstract Background To investigate the radiologic and prognostic outcomes after using arthroscopic-assisted reduction and internal fixation (ARIF) in complex tibial plateau fractures with mid- to long-term follow-up. Methods This retrospective study reviewed complex tibial plateau fractures that underwent ARIF from 1999 to 2019. Radiologic outcomes, including tibial plateau angle (TPA), posterior slope angle (PSA), Kellgren–Lawrence classification and Rasmussen radiologic assessment, were measured and evaluated. The prognosis and complications were assessed by the Rasmussen clinical assessment with a minimum follow-up of 2 years. Results Ninety-two consecutive patients (mean age: 46.9 years) with a mean follow-up of 74.8 months (24–180) were included in our series. Using AO classification, there were 20 type C1 fractures, 21 type C2 fractures, and 51 type C3 fractures. All the fractures achieved solid union. TPA was maintained well on average at the last follow-up and showed no significant difference compared to postoperatively (p = 0.208). In the sagittal plane, the mean PSA increased from 9.3 ± 2.9° to 9.6 ± 3.1° (p = 0.092). A statistically significant increase in PSA was also noted in the C3 group (p = 0.044). Superficial or deep infection was noted in 4 cases (4.3%), and total knee arthroplasty (TKA) was performed in 2 cases (2.2%) due to grade 4 osteoarthritis (OA). Ninety (97.8%) and 89 (96.7%) patients had good or excellent results in the Rasmussen radiologic assessment and Rasmussen clinical assessment, respectively. Conclusions The complex tibial plateau fracture could be treated successfully using arthroscopy-assisted reduction and internal fixation. Most patients achieve excellent and good clinical outcomes with low complication rates. In our experience, a higher incidence of increased slope was noted, especially in type C3 fractures. Reduction of the posterior fragment should be done cautiously during the operation. Levels of evidence Level III. |
| first_indexed | 2024-03-13T03:20:01Z |
| format | Article |
| id | doaj.art-4d48684b5ab049b1886c97a8404624fa |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-03-13T03:20:01Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-4d48684b5ab049b1886c97a8404624fa2023-06-25T11:23:02ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-06-011811910.1186/s13018-023-03938-8Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-upYou-Hung Cheng0Cheng-Pang Yang1Shih-Sheng Chang2Chun-Jui Weng3Chih-Hao Chiu4Yi-Sheng Chan5Department of Orthopedic Surgery, New Taipei Municipal Tu-Cheng Hospital, Chang Gung Memorial HospitalDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial HospitalDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial HospitalDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial HospitalDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial HospitalDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial HospitalAbstract Background To investigate the radiologic and prognostic outcomes after using arthroscopic-assisted reduction and internal fixation (ARIF) in complex tibial plateau fractures with mid- to long-term follow-up. Methods This retrospective study reviewed complex tibial plateau fractures that underwent ARIF from 1999 to 2019. Radiologic outcomes, including tibial plateau angle (TPA), posterior slope angle (PSA), Kellgren–Lawrence classification and Rasmussen radiologic assessment, were measured and evaluated. The prognosis and complications were assessed by the Rasmussen clinical assessment with a minimum follow-up of 2 years. Results Ninety-two consecutive patients (mean age: 46.9 years) with a mean follow-up of 74.8 months (24–180) were included in our series. Using AO classification, there were 20 type C1 fractures, 21 type C2 fractures, and 51 type C3 fractures. All the fractures achieved solid union. TPA was maintained well on average at the last follow-up and showed no significant difference compared to postoperatively (p = 0.208). In the sagittal plane, the mean PSA increased from 9.3 ± 2.9° to 9.6 ± 3.1° (p = 0.092). A statistically significant increase in PSA was also noted in the C3 group (p = 0.044). Superficial or deep infection was noted in 4 cases (4.3%), and total knee arthroplasty (TKA) was performed in 2 cases (2.2%) due to grade 4 osteoarthritis (OA). Ninety (97.8%) and 89 (96.7%) patients had good or excellent results in the Rasmussen radiologic assessment and Rasmussen clinical assessment, respectively. Conclusions The complex tibial plateau fracture could be treated successfully using arthroscopy-assisted reduction and internal fixation. Most patients achieve excellent and good clinical outcomes with low complication rates. In our experience, a higher incidence of increased slope was noted, especially in type C3 fractures. Reduction of the posterior fragment should be done cautiously during the operation. Levels of evidence Level III.https://doi.org/10.1186/s13018-023-03938-8Complex tibial plateau fractureArthroscopic-assisted reductionMinimally invasive internal fixation |
| spellingShingle | You-Hung Cheng Cheng-Pang Yang Shih-Sheng Chang Chun-Jui Weng Chih-Hao Chiu Yi-Sheng Chan Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up Journal of Orthopaedic Surgery and Research Complex tibial plateau fracture Arthroscopic-assisted reduction Minimally invasive internal fixation |
| title | Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up |
| title_full | Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up |
| title_fullStr | Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up |
| title_full_unstemmed | Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up |
| title_short | Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up |
| title_sort | arthroscopic assisted reduction and internal fixation for complex tibial plateau fracture radiographic and clinical outcomes with 2 to 15 year follow up |
| topic | Complex tibial plateau fracture Arthroscopic-assisted reduction Minimally invasive internal fixation |
| url | https://doi.org/10.1186/s13018-023-03938-8 |
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