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Complicated Tibial Plateau Fractures in Young Patients: Functional Outcome with Dual Plating through two Incision Technique

Vol 5 | Issue 1 | Jan-April 2019 | page: 28-31 |Abdul Qadir, Muhammad Muzzammil, Muhammad Tahir Lakho, Maratib Ali.


Author: Abdul Qadir [1],Muhammad Muzzammil [1], Muhammad Tahir Lakho [1], Maratib Ali [2]

1 Dept. Of orthopaedic surgery, Dr. Ruth  K.M Pfau Civil Hospital Karachi – Pakistan.

2 Dept. Of orthopaedic surgery, Jinnah Postgraduate Medical Center, Karachi Pakistan.

Address of Correspondence

Dr. Abdul Qadir
Orthopedic surgeon
Dr. Ruth K.M Pfau civil hospital
Dow university of health sciences
Karachi pakistan

Abstract

Objective: Motorbike accidents contribute one of the most important factors of tibial plateau fracture among young populations in Karachi Pakistan. Most surgeons feel challenging to treatment complicated bicondylar fractures of the tibial plateau.This prospective study was designed to evaluate the functional outcomes of dual plating through a two-incisions technique for the fixation of complicated bicondylar tibial plateau fractures in young patients in Karachi Pakistan.

Methods: This prospective study includes 94 cases of Type V and VI tibial plateau fractures of young patient’s age range from 15 to 45 years, operated between January 2014 and December 2016 conducted in two public sector hospital of Karachi Pakistan (Jinnah Post Graduate Medical Center, Civil Hospital Karachi). Exclusion criteria include patients with multiple fractures on the same side or same bone, age >45 years, open contaminated fracture, open fracture,and patients with head injuries. All cases were operated either by lateral locking plate fixation by anterolateral approach or dual plating through double incisions. These all cases were followed for a minimum of 24 months radiologically and clinically. The statistical analysis was performed using software SPSS 20.0 to analyze the data.

Results: A total of 94 patients (45 Single Plating and 49 Dual Plating)were operated during the study period of 2 years. However, four patients (4 single plating and 0 dual plating) were lost during follow-up who could not be tracked. Both groups were somewhat similar in relation to the age, mechanism of injury, fracture pattern, and soft tissue injury. Preoperatively, there was a significant increase in surgical time with the dual plating group; however, the mean time of reduction between the two groups was not significant. The decision to put bone graft was at the choice of the operating surgeon and was an intra operative decision with 74 (78.7%) patients receiving the bone graft. Post-operatively, there was no immediate difference in between the groups considering thermal alignment and reduction. It took approximately 4–5 months for the fractures to get united. There was normal union,non union or implant failure seen among those patients. There were 10 cases with superficial infection in wounds of dual plating group which were treated with culture sensitive antibiotics for average 2 weeks, healed subsequently. There were three patients found having an incidence of deep infection in a double plating group, wherein 2 patients were positive with Staphylococcus aureus and 1 patient with Escherichia coli was isolated. Extensive wound irrigation and lavage with antibiotic cement beads were given. Repeated irrigation and lavage were done again after 2 weeks with the removal of beads followed by prolonged course of antibiotic therapy for 6 weeks after which the infection resolved.A total of 38 (77%) patients in a double plating group regained full flexion (135°) and full extension (0°) with a good alignment and no pain and instability as compared to single plating group, seen in 30 (66%) patients at follow-up.

Conclusion: Dual plating by two-incision method resulted in better functional outcome regarding limb alignment and range of movements at knee joint with an acceptable soft tissue complication rate in young patients.

Keywords: Complicated tibial plateau fracture, Young patients, Double incision, Dual plating.


References

1. Suriyawongpaisal P, Kanchanasut S. Road traffic injuries in Thailand: Trends, selected underlying determinants and status of intervention. Inj Control SafPromot 2003;10:95-104.

2. Yang BM, Kim J. Road traffic accidents and policy interventions in Korea. Inj Control SafPromot 2003;10:89-94.

3. Ghaffar A, Hyder AA, Masud TI. The burden of road traffic injuries in developing countries: The 1st national injury survey of Pakistan. Public Health 2004;118:211-7.

4. Chalya PL, Mabula JB, Ngayomela IH, Kanumba ES, Chandika AB, Giiti G, et al. Motorcycle injuries as an emerging public health problem in Mwanza city, North-Western Tanzania. Tanzan J Health Res 2010;12:214-21.

5. Egol KA, Koval KJ. Fracture of Proximal Tibia: Chapter 50, Rockwood and Greens “Fracture in Adults”. 6th ed., Vol. 2. Philadelphia, PA: Lippincott Williams and Wilkins; 1999.

6. Schulak DJ, Gunn DR. Fractures of tibial plateaus. A review of the literature. Clin OrthopRelat Res 1975;109:166-77.

7. Cotton FB. Fender fracture of the tibia at the knee. N Engl J Med 1929;201:989.

8. Koval KJ, Helfet DL. Tibial plateau fractures: Evaluation and treatment. J Am AcadOrthopSurg 1995;3:86-94.

9. Phisitkul P, McKinley TO, Nepola JV, Marsh JL. Complications of locking plate fixation in complex proximal tibia injuries. J Orthop Trauma 2007;21:83-91.

10. Dendrinos GK, Kontos S, Katsenis D, Dalas A. Treatment of highenergy tibial plateau fractures by the ilizarov circular fixator. J Bone Joint Surg Br 1996;78:710-7.

11. Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev 1994;23:149-54.

12. Higgins TF, Klatt J, Bachus KN. Biomechanical analysis of bicondylar tibial plateau fixation: How does lateral locking plate fixation compare to dual plate fixation? J Orthop Trauma 2007;21:301-6.

13. Horwitz DS, Bachus KN, Craig MA, Peters CL. A biomechanical analysis of internal fixation of complex tibial plateau fractures. J Orthop Trauma 1999;13:545-9.

14. Jiang R, Luo CF, Wang MC, Yang TY, Zeng BF. A comparative study of less invasive stabilization system (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures. Knee 2008;15:139-43.

15. Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 2004;18:649-57.

16. Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN, et al. Complications after tibia plateau fracture surgery. Injury 2006;37:475-84.

17. Yoo BJ, Beingessner DM, Barei DP. Stabilization of the posteromedial fragment in bicondylar tibial plateau fractures: A mechanical comparison of locking and nonlocking single and dual plating methods. J Trauma 2010;69:148-55.

18. Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: Definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma 1987;1:97-119.

19. Stevens DG, Beharry R, McKee MD, Waddell JP, Schemitsch EH. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 2001;15:312-20.

20. Zhang Y, Fan DG, Ma BA, Sun SG. Treatment of complicated tibial plateau fractures with dual plating via a 2-incision technique. Orthopedics 2012;35:e359-64.

21. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C, et al. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin OrthopRelat Res 2005;439:207-14.


How to Cite this article:  Qadir A, Muzzammil M, Lakho M T, Ali M. Complicated Tibial Plateau Fractures in Young Patients: Functional Outcome with Dual Plating through two Incision Technique. Trauma International Jan-Aprl 2019;5(1):28-31.

 


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