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PURPOSE: The primary aim of the present study was to compare basic characteristics of patients requiring early treatment with TKR and patients not requiring TKR within 3 years following a lateral tibial plateau fracture.METHODS: Comparative cohort study. From December 2013 to November 2016, 56 patients were included. Five patients required a TKR within the first 3 years. We compared the basic characteristics (age, gender, BMI, comorbidity, osteoporosis, fracture classification, soft tissue injuries and trauma mechanism) between patients.RESULTS: Comparing baseline characteristics of the two groups of patients shows a higher rate of females (56.4% vs 80%), a higher BMI (25.9 vs 29.9), a higher rate of patients with diabetes (8% vs 20%), a higher rate of the fracture type AO 41-B1 (8% vs 80%) and a higher rate of soft tissue injuries (46% vs 100%). Age, smoking status and preoperative maximum joint depression were comparable between the two groups.CONCLUSIONS: Female gender, severe comorbidity, obesity, osteopenia, fracture type AO 41-B and soft tissue injuries were associated to early total knee replacements following surgically treated lateral tibial plateau fractures.

Objective: The aim of our study was to evaluate the functional outcome using the HSS knee scoring system and complications of tibia plateau fractures in the Indian population treated with the Locking Anterolateral plate with the MIPO technique. Method: A prospective study was carried out in our institute at Kolhapur. A total number of 57 patients with tibia plateau fracture (AO/OTA type 41-B, C) were studied between March 2019 and Jan 2021. All were treated with an anterolateral locking plate via anterolateral approach and MIPO technique. A mean follow-up of 12 months was carried out, and evaluation was done with the help of the HSS (Hospital for special surgery) Knee scoring system. Result: The mean radiological union time was 16 weeks. The outcome was measured using HSS knee scoring. The average follow up period was 12 months with good patient satisfaction. A total of 11 patients out of 57 reported complications like Non-union (2%), Delayed union (7%), Infection (5.20%) and hardware irritation (5.20%). No case of peripheral neuropathies reported in any of the patients. Conclusion: Locking anterolateral plating via the MIPO technique is a good treatment option showing good clinical outcome in the treatment of tibia plateau fracture (AO/OTA type 41-B, C). It offers a more stable fixation and good functional recovery after the surgery.

Intra-articular corrective osteotomy can be used to restore the anatomic position of knee surfaces for tibial plateau malunion (TPM) but precise restoration is not easy. The personalized surgical guide (PSG) might improve the TMP outcomes. This study developed a two-staged PSG method to provide registration and drill the bone for subsequent osteotomy. The tests were performed to compare the accuracy the proposed PSG and the conventional guide (Anterior cruciate ligament guide, ACLG). The results showed that the PSG provides better accuracy (0.50 ± 0.19 mm) than the ACLG (1.58 ± 0.67 mm). The results show the PSG method is a feasible alternative to the conventional ACLG procedure.

Die sichere Diagnostik und Klassifikation proximaler Femur- und Tibiafrakturen ist zur Festlegung des therapeutischen Vorgehens essenziell. In diesem Beitrag werden die aktuellen Standards bezuglich der Bildgebung im Bereich des proximalen Femurs und der Tibia dargestellt sowie die Wertigkeit verschiedener Klassifikationssysteme eingeordnet. Das konventionelle Rontgenbild in 2 Ebenen bleibt die Grundlage zur Frakturdiagnostik in beiden Lokalisationen. Wahrend am proximalen Femur eine weiterfuhrende Diagnostik oft nicht notwendig ist, muss diese im Bereich der proximalen Tibia regelhaft erfolgen.

Purpose: In-hospital three-dimensional (3D) printing of patient-specific pathologies is increasingly being used in daily care. However, the efficiency of the current conversion from image to print is often obstructed due to limitations associated with segmentation software. Therefore, there is a need for comparison of several clinically available tools. A comparative study has been conducted to compare segmentation performance of Philips IntelliSpace Portal(®) (PISP), Mimics Innovation Suite (MIS), and DICOM to PRINT(®) (D2P). Approach: These tools were compared with respect to segmentation time and 3D mesh quality. The dataset consisted of three computed tomography (CT)-scans of acetabular fractures (ACs), three CT-scans of tibia plateau fractures (TPs), and three CTA-scans of abdominal aortic aneurysms (AAAs). Independent-samples [Formula: see text]-tests were performed to compare the measured segmentation times. Furthermore, 3D mesh quality was assessed and compared according to representativeness and usability for the surgeon. Results: Statistically significant differences in segmentation time were found between PISP and MIS with respect to the segmentation of ACs ([Formula: see text]) and AAAs ([Formula: see text]). Furthermore, statistically significant differences in segmentation time were found between PISP and D2P for segmentations of AAAs ([Formula: see text]). There were no statistically significant differences in segmentation time for TPs. The accumulated mesh quality scores were highest for segmentations performed in MIS, followed by D2P. Conclusion: Based on segmentation time and mesh quality, MIS and D2P are capable of enhancing the in-hospital 3D print workflow. However, they should be integrated with the picture archiving and communication system to truly improve the workflow. In addition, these software packages are not open source and additional costs must be incurred.

Purpose The existing classification systems of tibial plateau fracture (TPF) are suboptimal for clinical use and academic communication. A more comprehensive and universal classification system with the capability to analyze all patterns of TPF is urgently required to guide the clinical practice. This study aimed to analyze the incidence and fracture characteristics of TPF using a computed tomography-based “four-column and nine-segment” classification. Methods According to the differentiated morphological characteristics, tibial plateau and proximal fibula were divided into four columns, which were subdivided into nine segments. Tibia plateau injury index (TPII) was innovatively introduced to represent the extent of injury. A total of 698 consecutive adult patients with 704 affected knees were included (377 females, 321 males, mean age 51.6 ± 12.9 years). Fracture mapping was retrospectively analyzed according to the new-style classification system based on the CT imaging. Results 371 (53.2%) left knees and 321 (46.0%) right knees were injured solely and 6 (0.9%) cases sustained bilateral injuries. The rates of one-column, two-column, three-column and all-four-column injuries were 30.5%, 31.5%, 28.0% and 9.9%, respectively. On average, 2.2 ± 1.0 columns and 3.6 ± 2.1 segments were involved, the mean TPII was 5.7 ± 3.0. The rates of mild, moderate and severe comminuted fractures were 50.0%, 37.5% and 12.5%. The most frequently affected columns were lateral column (572, 81.3%) and intermedial column (524, 74.4%), and the less frequently involved columns were the medial column (219, 31.1%) and fibular column (218, 31.0%). The most frequently affected segments were the posterolateral segment (465, 66.1%), anterolateral segment (453, 64.3%) and posteromedian segment (379, 53.8%). The least frequently involved segment was tubercle segment (85, 12.1%). Conclusions The novel “four-column and nine-segment” classification will be a beneficial classification system for clinical diagnosis, statistical analysis and prognostic judgment of tibial plateau fractures.

Background Tibia plateau fractures are most commonly managed with open reduction and internal fixation (ORIF) technique, external fixation via minimally invasive technique are an excellent alternative. The aim of this study was to assess the results of tibia plateau fractures by using the Ilizarov external fixator. The analysis was done both clinically and radiologically. Methodology Some 72 patients with isolated tibia plateau fractures were brought to ED and clinics and assessed. The fractures were classified according to Schatzker Tibia Plateau Fracture classification, only Schatzker type III to VI were included using conventional X-rays. All patients for their tibia plateau fractures underwent surgical correction using Ilizarov technique with full weight bearing and knee range of motion allowed the next day. Patient follow-up up to one year was done. KOOS and self-appraisal were used to evaluate the knee pain and function. Results All the fractures healed with 67 patients achieving a range of motion better than 0-100o. KOOS score shows that patients who had worse fracture patterns (Schatzker-V and VI) have worse global scores (p=0.002); still when managed with an Ilizarov it has been seen that these patients are able to maintain a moderately pain free knee (p=0.013) other aspects of the KOOS. Patients with higher BMI showed to have worsening fracture patterns with 20 out of the 30 overweight patients suffering Schatzker-V (66.67%). We experienced an extremely low rate of pin tract infections with only two debridements required. Conclusion Ilizarov external fixation method is a valuable alternative treatment with excellent clinical outcomes and early mobilization.

To review available approaches and fixation methods for posterolateral fracture fragment (PLF) in tibial plateau fracture, and to propose an algorithm to treat various types of plateau fractures which all involve the PLF. This article reviews multiple surgical approaches for PLF and suggests an algorithm for suitable approach and fixation method according to PLF with combined plateau fracture. The modified anterolateral approach is a suitable single approach for fractures with a PLF combined with an anterolateral plateau fracture and for isolated posterolateral fracture fragments. For a multicolumn tibia plateau fracture involving the lateral, medial and posterior columns, dual approaches (modified anterolateral and posteromedial approach) can be used to access the entire plateau area. When considering approaches of this complex fracture pattern, one must consider local soft tissue condition, plateau fracture morphology, associated injuries, and fixation options. After review of multiple approaches described in the literature for PLF fixation, we can suggest an algorithm for the approach and fixation to treat tibial plateau fractures with posterolateral fracture fragments.

This study was aimed to assess the opportunity of using CT scan exam with 3- D reconstruction in children with tibia plateau fractures. This type of fracture occurs rarely in the paediatric population, generally in older children, either as isolated lesion or part of multiple trauma. Appropriate radiology diagnosis is required for classifying the fracture according to Schatzker’s criteria and deciding the treatment plan. There are still controversies in the literature regarding the use of CT scan examination as part of the diagnosis protocol. We present two cases of children with knee trauma in which the standard X- Ray exam was equivocal in identifying the type of tibia plateau fracture. Detailed view of fracture anatomy was obtained by using CT- Scan exam with 3- D reconstruction. Surgery was performed in accordance with these data, and the outcome was favourable in both cases. We consider that CT- Scan with 3- D reconstruction is useful for planning surgery in children with tibia plateau fractures. This examination protocol should be routinely used in such difficult cases.

Aims and Objectives: Anterior cruciate ligament (ACL) ruptures are often concomitated by posterolateral bone bruise in the MRI. This is caused by a ventral subluxation of the tibia and impact of the femur in the posterolateral tibia plateau. In some cases, this impact causes a fracture of the posterolateral tibia plateau, the so-called Apple-Bite-Fracture. The increased posterior slope can cause additional instability and has to be considered as a risk factor for ACL failure. In this study we investigated the short term clinical outcomes of patients with this combined injury. Materials and Methods: Retrospective study of 14 patients (mean age 46 ± 12,3) (8 male, 6 female) with a mean follow up of 23,75 months. Different treatment strategies were analyzed. The clinical evaluation included visual analog score (VAS) increasing from 0-10 for Pain, IKDC Score, Rasmussen score as well as a clinical evaluation. Results: First analysis of the treatment options revealed a non-uniformed therapy strategy. In three patients the ACL tear was treated nonsurgical. In 11 patients the ACL tear was addressed surgical: six times the ACL was reconstructed with hamstring tendon graft, two times the ACL was sutured. Two patients treated with a non-reconstructive technique to promote healing (“healing response”). In one patient a tibial eminence fracture was fixated with a screw. The fracture of the posterolateral tibia plateau was in nine cases minimally invasive reduced and fixated with a screw osteosynthesis in jail technique. Two patients needed posterior buttress plate. Three times the large bone defect has been augmented with autologous bone graft from the pelvis. The postoperative clinical testing did not reveal any persisting knee instabilities. All patient had a non-limited ROM. No significant differences in ROM in comparison to the contralateral knee was seen. One patient reported persisting knee pain (VAS 3). All other patients reported no pain (VAS 0). Subjective IKDC score was 78,18 (71,3 - 83,9; ± 5,68). Clinical Rasmussen scores ranged from 27 to 30 (mean 27, ± 3,0). Rasmussen radiological results ranged from 16 to 18, mean 16,67 (± 1,15). Conclusion: Despite a very small patient number and leck of statistical power the new patient-spedific mini-metal implant seems to be a good options fort he treatment of middle-aged patients who already underwent frustane cartilage surgery. In these relatively rare caes early unicompartimental arthroplasty can be prevented. Further clinical studies with larger patient collectives have to prove the effectiveness of this new technique.

A 67-year-old male involved in a 35 mile/h motorcycle collision. He presented to the emergency room with right lower extremity deformity. Vascular exam demonstrated an ankle brachial index (ABI) of 0.9, and tense compartments were noted on palpation. The patient was intubated secondary to closed head injury, rendering the motor and sensory exam impossible. Skin and soft-tissue envelope were intact.

The patient is a 39-year-old female involved in a low-speed motor vehicle accident in which her car was rear-ended and then fishtailed into an embankment. On arrival to the emergency department, her Glascow Coma Scale was 15, and she was complaining of bilateral knee pain. Plain radiographs of bilateral knees demonstrated split-depression fractures of bilateral lateral tibial plateaus (Shatzker II). Computed tomography scans of both knees were obtained, and the diagnosis was confirmed. The patient was then taken to the operating room the same day for operative fixation of bilateral tibial plateaus (Figs. 1.1 and 1.2).

The patient is a 59-year-old female who slipped and fell on ice landing on her left lower extremity. The patient was evaluated in the emergency department, where she complained of isolated left knee pain. Her knee was moderately swollen without open wounds. The compartments of her lower extremity remained soft without evidence of compartment syndrome. Examination found her to be motor and sensory intact. Her past medical and surgical history is noncontributory.

Introduction: The aim of the study was to investigate the role of the intra-operative three-dimensional imaging in the tibial plateau fractures with complex depressions. Material and methods: Thirty tibial plateau fracture patients with complex depression were treated with the use of intra-operative three-dimensional imaging (Arcadis 3D). The image quality as well as the clinical benefit was evaluated. Results: In total 74 plates were used in these 30 patients. Six Kirschner wires and 50 screws were used outside the plate as raft technique in 4 and 21 patients. The additional critical imaging information which was unachievable in plain fluoroscopy was gain in 12 patients. Four patients among these 12 patients were revised because of the depression. Two patients were revised due to the misplacement of screws. Conclusion: The intra-operative three-dimensional imaging (Arcadis) is necessary when the two-dimensional fluoroscopy was unsatisfactory in the depressed tibial plateau fracture.

Objectives: Arthrofibrosis is a serious complication following the reconstruction of anterior cruciate ligament (ACL) and posterolateral corner (PLC) injury. Loss of motion caused by arthrofibrosis can be disabling in young and active patients. We report the clinical results of the treatment of arthrofibrosis following arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft and surgically repairing PLC with 2 suture anchors in a 30 year-old professional dancer, treated with surgical lysis and manipulation under general anesthesia followed by aggressive physical therapy. Methods: A 30 year-old male professional dancer presented with pain, effusion and severe instability in his left knee after falling in a dance event. The pain was evaluated on Visual analog scale (VAS) as 6 to 8. At the physical examination, anterior drawer test was evaluated as grade 3, pivot shift test, varus test, dial test and posterolateral drawer test were found positive. The Tegner Lysholm score was evaluated as 22 (poor). Under general anesthesia, left knee had tendency to external rotation and recurvatum when leg was suspended by toes. A magnetic resonance image (MRI) revealed the presence of a total ACL rupture, PLC injury and a fracture of lateral tibia plateau. The patient was treated with arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft fixed with endobutton through femoral tunnel and bio interference screw through tibial tunnel and PLC injury was treated with 2 suture anchors. Postoperatively first day, quadriceps musculature and active and passive ROM exercises was trained. During postoperatively third week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. At the sixth week, arthroscopic lysis was performed due to type 3 arthrofibrosis. At the tenth week, manipulation was performed to the left knee under general anesthesia. Results: At the 3 month- follow-up, the patient achieved full symmetric restoration of motion and he had returned to full daily activities. The Tegner Lysholm score was evaluated as 94 (excellent) postoperatively. Functional examination of the left knee reveled 155 of flexion, and full knee extension. The complaint of instability was disappeared. At 9 month-follow-up, clinical findings were unremarkable, with no sign of re-rupture and arthrofibrosis and he returned to his professional dance career. Conclusion: In the literature there is not any consensus regarding the management and rehabilitation intervention for arthrofibrosis in young athletes or professional dancers. The best treatment method is preventing the arthrofibrosis once it has occurred with surgical lysis and aggressive physical therapy. The combined surgical treatment and physiotherapy described in this case report may assist clinicians in the treatment of arthrofibrosis after arthroscopic reconstruction of ACL and PLC injury.

Injury to the lower extremities play a major role in sports (soccer, skiing, etc.). They have furthermore emerged as the most frequent non-minor injury resulting from frontal vehicle crashes since restraint systems (belts, airbag in frontal impacts) are not particularly designed for the protection of the legs (and arms). Yet, injuries of the extremities are often the reason for long-term impairment [Haland et al. 1998, Crandall 2001].

Within the last decade computed tomography has become an important instrument for skeletal diagnosis. In this study the value of helical CT-scan was compared with plan X-rays and conventional tomography in 45 patients having sustained an intraarticular tibia plateau fracture. Between plan roentgenogramms and CT-scan the fracture classification according to the AO-classification was changed in 40% of all patients, in 39 cases the amount of impression or dislocation increased with a mean of 4.2 mm. Especially tiny fragments were better visible and therefore responsible for the shift of many B1 fractures to group B3. The difference between conventional tomography and computed tomography was less impressive, a change of fracture classification could be observed in only 6.7% of all cases.

Preventing fractured joint from arthritic change remains a challenge, especially in weight-bearing joints. Hyaluronan (HA) has been proved to effectively relieve pain and improve function in chronic osteoarthritis (OA) joint. However, controversies still exist in its potential use in fractured joints and whether this effect is molecular weight dependent. We analyzed and compared the effects of two different molecular weight HAs on six OA-related factors expression in fibroblast-like synoviocytes (FLS) from twelve patients with tibia plateau fracture

Arthroscopy is playing an increasing role in the management of tibia plateau fractures. We present its use in a Nigerian patient with malunited tibia plateau fracture. A 37-yearold male teacher with a 4-month-old left tibia plateau fracture presented with pain, instability, and deformity. He had arthroscopic evaluation followed by medial opening wedge corrective osteotomy. At 4 months follow-up, he was pain free and had a stable knee. Arthroscopy can be successfully used and is beneficial in the treatment of a malunited tibia plateau fracture. This case highlights the possible benefits of arthroscopy in case of this very complex injury. As the practice of arthroscopy and other minimally invasive surgeries becomes more widespread in Nigeria, we hope that more surgeons will incorporate this in their practice.

245 Copyright c 2014 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Address reprint requests to: Kang-Il Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea Tel: 82-2-440-7497ᆞFax: 82-2-440-7498 E-mail: drkim@khu.ac.kr Financial support: None. Conflict of interest: None. 경골 고평부 골절 치료의 최신 지견 이상학⋅김강일

191 통신저자:이 광 철 광주시 동구 필문대로 365, 조선대학교병원 정형외과 Tel:062-220-3147ᆞFax:062-226-3379 E-mail:leekci@chosun.ac.kr 이 논문은 2009년도 조선대학교 학술연구비의 지원을 받아 연구되었음. 접수: 2013. 1. 29 심사(수정): 2013. 3. 12 게재확정: 2013. 4. 25 Address reprint requests to:Gwang Chul Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea Tel:82-62-220-3147ᆞFax:82-62-226-3379 E-mail:leekci@chosun.ac.kr