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Comparison of Various Modalities of Treatment for Tibial Plateau Fracture

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 12-15 | Prafulla Herode, Abhijeet Shroff, Mohan Sadaria, Jeegar Patel, Satish Uchale Author: Prafulla Herode [1], Abhijeet Shroff [1], Mohan Sadaria [2], Jeegar Patel [1], Satish Uchale [1]. [1]Department of Orthopaedics, Dr. D. Y. Patil Hospital and Medical College,Pimpri,Pune, India, [2]Senior Consultant and […]

Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 16-20 | M. Shoaib Qureshi, Mangesh Panat, Pratik Israni Author: M. Shoaib Qureshi [1], Mangesh Panat [1], Pratik Israni[1]. [1]Department Of Orthopedics, Mgm Hospital & Research Centre, Aurangabad, India Address of Correspondence Dr. Mangesh Panat, Dept. of orthopedics, mgm medical college and hospital. […]

Comparison of Various Modalities of Treatment for Tibial Plateau Fracture

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

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Comparison of Various Modalities of Treatment for Tibial Plateau Fracture

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 12-15 | Prafulla Herode, Abhijeet Shroff, Mohan Sadaria, Jeegar Patel, Satish Uchale

Author: Prafulla Herode [1], Abhijeet Shroff [1], Mohan Sadaria [2], Jeegar Patel [1], Satish Uchale [1].

[1]Department of Orthopaedics, Dr. D. Y. Patil Hospital and Medical College,Pimpri,Pune, India,
[2]Senior Consultant and Orthopaedic Surgeon, Sadaria Orthopaedic Hospital, Surat, Gujarat, India.

Address of Correspondence
Dr. Abhijeet Shroff,
Department of Orthopaedics, Dr. D. Y. Patil Hospital and Medical College, Pimpri, Pune, India.
E-mail: drjmsadaria@gmail.com

Learning Points for this Article: Thus we learned that Displaced/Depressed intraarticular fractures belonging to Schatzker’s type I, II and III should be treated by surgical methods,ORIF gives satisfactory results by maintaining precise articular congruity and preventing early osteoarthritis.

Abstract

Background: Tibial plateau fractures are quite challenging for orthopaedic surgeons,and earlier, most of tibial plateau fractures were treated conservatively which resulted in joint line incongruity, early osteoarthritis, and knee stiffness. Now, treatment of these fractures has changed. We did this study to compare the outcome of different modalities of treatment in tibial plateau fractureswith advantages and disadvantages.
Materials and Methods: During 2 years from April 2015 to May 2017, 30 patients were treated for closed tibial plateau fractures, of which 4 patients were treated by conservative methods, and 26 patients were treated by surgical methods.
Results: Result showed the higher involvement of young, middle-aged males than older females with maximum Type I fractures. Operative results were better in complicated fractures which treated with buttress plate where there was no much difference in the outcome of simple TypesI and II fractures, and hence, we preferred conservative modality for them.
Conclusion: The correct method of management of tibial condylar fractures depends on good clinical judgment. If rational treatment is to be instituted, the surgeon must have sound knowledge of the pattern of the injury and a clear understanding of the knee examination and imaging studies and must be familiar with a variety of techniques available at present for treating tibial condyle fractures.
Keywords: Tibial plateau, conservative, cannulated cancellous screw, buttress plate.

References

1. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res 1979;138:94-104.
2. Jensen DB, Rude C, Duus B, Bjerg-Nielsen A. Tibial plateau fractures. A comparison of conservative and surgical treatment. J Bone Joint Surg Br 1990;72(1):49-52.
3. Bowes DN, Hohi M. Tibial condyle fracture: Evaluation of treatment and out come. Clin Orthop 1982;171:104.
4. Blokker CP, Rorabeck CH, Bourne PB. Tibia plateau fractures – An analysis of the results of treatment in 60 patients. Clin Orthop 1984;182:193-198.
5. Ebraheim NA, Sabry FF, Haman SP. Open reduction and internal fixation of 117 tibial plateau fractures. Orthopedics 2004;27(1):1281-1287.
6. Lansinger O, Bergman B, Körner L, Andersson GB. Tibial condylar fractures. A twenty-year follow-up. J Bone Joint Surg Am 1986;68(1):13-19.
7. Sament R, Mayanger JC, Tripathy SK, Sen RK. Closed reduction and percutaneous screw fixation for tibial plateau fractures. J Orthop Surg (Hong Kong) 2012;20(1):37-41.
8. Raza H,Hashmi P, Abbas K, Hafeez K. Minimally invasive percutaneous plate osteosynthesis in tibia plateau fractures. J Orthop Surg 2012;20(1):42-47.

How to Cite this article: Herode P, Shroff A, Sadaria M, Patel J, UchaleS. Comparison of Various Modalities of Treatment for Tibial Plateau Fracture. Trauma International Sep – Dec 2017;3(2):12-15.

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Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 16-20 | M. Shoaib Qureshi, Mangesh Panat, Pratik Israni

Author: M. Shoaib Qureshi [1], Mangesh Panat [1], Pratik Israni[1].

[1]Department Of Orthopedics, Mgm Hospital & Research Centre, Aurangabad, India

Address of Correspondence
Dr. Mangesh Panat,
Dept. of orthopedics, mgm medical college and hospital.
Email: mangeshpanat@yahoo.co.in

Learning Points for this Article: This article will focus on successful management of proximal tibia fractures with impending compartment syndrome in two stages supporting the practice of delayed internal fixation until the soft-tissue envelope allows for definitive fixation.

Abstract

Introduction: High energy proximal tibia fractures with soft tissue involvement presenting with dicolored patches over the leg and severe swelling, compound wounds, blisters with tight compartments and absent or feeble dorsalis pedis or posterior tibial arteries warrant to go in for a staged procedure. In patients with multiple injuries, an external fixator can be applied quickly with minimal blood loss for unstable periarticular fractures around the knee. Two-stage procedures involve (1) early joint spanning external fixators with fasciotomy for the medial and posterior compartments, (2) and late definitive fixation with plates or nails and with skin grafting.
Materials and Methods: In our study, we present a short series of 15 proximal tibial fractures with impending compartment syndrome. Patients selected for this study were (1) closed proximal tibia fracture intra- and peri-articular and metaphysis diaphysis junction communited and noncommunited fractures (2) impending compartment syndrome evaluated based on excessive swelling, tight compartments, blisters over skin, feeble or absent dorsalis pedis or posterior tibial pulsations, color Doppler suggestive of severe subcutaneous edema associated with monophasic or absent flow over distal arteries.
Exclusion criteria: (1) Low energy proximal tibia fracture without soft tissue insult and compound wounds over the proximal tibia fractures, (2) associated popliteal artery injuries.
Conclusion: With the initial application of a bridging external fixator followed by delayed internal fixation protocol for pilon fractures has been successful in reducing the historically high rates of wound complications associated with these high-energy injuries. As well this protocol allows the use of minimally invasive plate osteosynthesis technique which is based on a combination of the principles of stability, restoration of anatomy and early motion while eliminating the need for excessive soft tissue dissection.
Keywords: Proximal Tibial fractures, External fixators, Fasciotomy, Definitive fixation.

References

1. Dougherty PJ, Silverton C, Yeni Y, Tashman S, Weir R. Conversion from temporary external fixation to definitive fixation: Shaft fractures. J Am Acad Orthop Surg 2006;14:S124-S127.
2. Chan PS, Klimkiewicz JJ, Luchetti WT, Esterhai JL, Kneeland JB, Dalinka MK, et al. Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma 1997;11(7):484-489.
3. Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002;84(9):1541-1551.
4. Ricci WM, Rudzki JR, Borrelli J Jr. Treatment of complex proximal tibia fractures with the less invasive skeletal stabilization system. J Orthop Trauma 2004;18(8):521-527.
5. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 2005;439:207-214.
6. Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): The results of a prospective, standardized protocol. J Orthop Trauma 2005;19(7):448-455.
7. Watson JT, Moed BR, Karges DE, Cramer KE. Pilon fractures. Treatment protocol based on severity of soft tissue injury. Clin Orthop Relat Res 2000;78-90.
8. Haidukewych GJ, Collinge CA. Conversion of Temporary External Fixation to Formal Internal Fixation for Complex per Articular Injuries of the Lower Extremity: Is there an Infection risk? Presented at the American Academy of Orthopaedic Surgeons Annual Meeting, Dallas, Texas; 2002.

How to Cite this article: Qureshi MS, Panat M, Israni P. Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation. Trauma International Sep-Dec 2017;3(2):16-20.

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Comparison of Various Modalities of Treatment for Tibial Plateau Fracture

Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

Comparison of Various Modalities of Treatment for Tibial Plateau Fracture

Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

Full Sized Blog Element (Big Preview Pic)

Comparison of Various Modalities of Treatment for Tibial Plateau Fracture

Author: Prafulla Herode [1], Abhijeet Shroff [1], Mohan Sadaria [2], Jeegar Patel [1], Satish Uchale [1].

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

Author: M. Shoaib Qureshi [1], Mangesh Panat [1], Pratik Israni[1].

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

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