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Introduction: Preoperative planning is a critical step in the success of any complex surgery. The pur-pose of this study is to evaluate the advantage of VR glasses in surgical planning of complex tibial plateau fractures compared to CT planning. Materials and methods: Five orthopedic surgeons performed preoperative planning for 30 fractures using either conventional CT slices or VR visualization with a VR headset. Planning was performed in a randomized order with a 3-month interval between planning sessions. A standardized questionnaire assessed planned operative time, planning time, fracture classification and understanding, and surgeons' subjective confidence in surgical planning. Results: The mean planned operative time of 156 (SD 47) minutes was significantly lower (p < 0.001) in the VR group than in the CT group (172 min; SD 44). The mean planning time in the VR group was 3.48 min (SD 2.4), 17% longer than in the CT group (2.98 min, SD 1.9; p = 0.027). Relevant parameters influencing planning time were surgeon experience (-0.61 min) and estimated complexity of fracture treatment (+ 0.65 min). Conclusion: The use of virtual reality for surgical planning of complex tibial plateau fractures resulted in significantly shorter planned operative time, while planning time was longer compared to CT planning. After VR planning, more surgeons felt (very) well prepared for surgery. [ABSTRACT FROM AUTHOR]

Aims: This study aims to compare the outcomes of immediate (followed by closed-incision negative-pressure therapy use) versus delayed ORIF in patients with Schatzker type IV–VI TPFs. Patients and Methods: A prospective study of patients undergoing ORIF between January 2018 and December 2019 was performed. The inclusion criteria were patients (>18 years) with a closed fracture sent to the emergency room (ER) within 24 h of injury. All the patients underwent preoperative image evaluation. Two senior orthopedic trauma surgeons evaluated the soft tissue condition in the ER by 5P's of the compartment syndrome, judging the timing of the operation of definitive ORIF. Group 1 (n = 16) received delayed ORIF. Group 2 (n = 16) received immediate ORIF and ciNPT use. Patient follow-up occurred after 2 and 6 weeks and 3, 6, and 12 months after surgery. The assessments included the time to definitive fixation, the length of hospital stay, the time to bone union, surgical site complications, and reoperation within 12 months. A universal goniometer was used to measure the postoperative 3 m, 6 m, and 12 m ROM. Results: The patient demographics were similar between the groups (p > 0.05). Group 2 displayed significantly a shorter time to definitive fixation (5.94 ± 2.02 vs. 0.61 ± 0.28, p < 0.0001) and hospital stay (14.90 ± 8/78 vs. 10.30 ± 6.78, p = 0.0016). No significant difference was observed in the time to bone union, surgical site complication incidence, and reoperation rates (p > 0.05). Flexion and flexion–extension knee ROM were demonstrated to be significantly improved in Group 2, 3, 6, and 12 months postoperatively (p < 0.0001). Conclusions: In this study, early ORIF and ciNPT use resulted in a shorter hospital length of stay, a reduced time to early active motion of the knee, and improved knee ROM. These results suggest that early ORIF with ciNPT for Schatzker type IV–VI TPFs is safe and effective in some patients. However, further research to confirm these findings across larger and more diverse populations is needed. [ABSTRACT FROM AUTHOR]

Introduction: There is still no consensus on the length of the non-bearing period required for tibial plateau fractures (TPFs) treated surgically. Several studies showed that full weight bearing immediately postoperatively does not affect fixation or cause joint collapse in patients with TPF. While there are concerns about weight bearing in the elderly due to fragile bone quality, their physical disability often makes it difficult to carry out activities of daily life when weight bearing is not allowed. The purpose of this study was to assess differences in clinical and radiographic outcomes between an early weight-bearing (EWB) group and a non-weight-bearing (NWB) group following TPF in elderly patients. Material and Methods: We extracted the data of 432 patients who suffered TPF from January 2011 to December 2020 from a database which is named TRON. We excluded patients with insufficient follow-up postoperatively, AO type A/C fracture, age < 60 years old, multiple trauma, and those lost to follow-up. Finally, 91 patients were eligible. EWB group patients were encouraged to perform partial weight-bearing walking at ≤ 4 weeks after surgery, whereas NWB group patients were not allowed weight bearing for > 4 weeks after surgery. Baseline intergroup differences were adjusted for by matching age, sex, body mass index, smoking history, and injury mechanism. We compared Knee Society Score (KSS), timing of full weight bearing, and X-ray findings including step-off, tibia plateau angle, plateau slope, and condylar widening in the X-rays between the two groups. Results: There were no significant statistical differences between the EWB group and NWB group after matching. The mean follow-up period was 28.0 (range 12–73) months. All cases did not require reoperation or additional procedures. The median KSS at 12 months or at the last follow up postoperatively was 100 (77–100) vs. 95 (75–100) points (P = 0.33). There were no differences in fracture-related infection rates or wound dehiscence. In the radiological evaluation of EWB and NWB, the correction loss of condylar widening was only significantly greater for EWB compared to NWB. Conclusions: We found that early weight bearing could contribute to increased condylar widening. While our short-term follow-up didn't reveal any significant clinical differences, this highlights the need for long-term follow-up to comprehensively understand the implications of these radiographic changes. [ABSTRACT FROM AUTHOR]

Tibial plateau fractures (TPFs) are one of the most challenging intra-articular fractures to treat. Along with reconstruction of the articular surfaces, appropriate alignment of the knee joints must be obtained and maintained after open reduction and internal fixation (ORIF) for TPFs because loss of alignment (LA) is associated with worse clinical outcomes. We aimed to investigate and clarify the risk factors related to LA after ORIF for TPFs. This multicenter, retrospective cohort study used data of hospitals of the Trauma Research Group (TRON group) from January 1, 2011, to December 31, 2020. Among 293 TPFs extracted from the database, we evaluated the alignment of the articular surface to the anatomical axis of the tibia in the immediate postoperative and last follow-up radiographs. We defined a change of alignment from the immediate postoperative radiograph as LA. We evaluated the risk factors of LA using univariate and multiple logistic regression analyses. LA was observed in 27 fractures (9.2%). In multiple logistic regression analyses, preoperative articular step-off and postoperative condylar widening were statistically associated with LA (OR = 1.1, 95% CI: 1.02–1.19 and P = 0.012; OR = 1.04, 95% CI: 1.00–1.08, P = 0.045, respectively). We calculated the threshold by drawing a receiver operating characteristic curve using the final regression model. The threshold of postoperative widening was 8.2 mm. We divided the 293 TPFs into two groups according to this threshold and determined differences between the two groups using Fisher's exact test. The two groups were statistically significantly different (P = 0.00502). Preoperative articular step-off and postoperative condylar widening could be associated with LA after ORIF for TPFs. We suggest that intraoperative restoration of condylar widening is important for the prevention of malalignment following ORIF for TPF. [ABSTRACT FROM AUTHOR]

Aims: This study aims to compare the outcomes of immediate (followed by closed-incision negative-pressure therapy use) versus delayed ORIF in patients with Schatzker type IV–VI TPFs. Patients and Methods: A prospective study of patients undergoing ORIF between January 2018 and December 2019 was performed. The inclusion criteria were patients (>18 years) with a closed fracture sent to the emergency room (ER) within 24 h of injury. All the patients underwent preoperative image evaluation. Two senior orthopedic trauma surgeons evaluated the soft tissue condition in the ER by 5P’s of the compartment syndrome, judging the timing of the operation of definitive ORIF. Group 1 (n = 16) received delayed ORIF. Group 2 (n = 16) received immediate ORIF and ciNPT use. Patient follow-up occurred after 2 and 6 weeks and 3, 6, and 12 months after surgery. The assessments included the time to definitive fixation, the length of hospital stay, the time to bone union, surgical site complications, and reoperation within 12 months. A universal goniometer was used to measure the postoperative 3 m, 6 m, and 12 m ROM. Results: The patient demographics were similar between the groups (p > 0.05). Group 2 displayed significantly a shorter time to definitive fixation (5.94 ± 2.02 vs. 0.61 ± 0.28, p < 0.0001) and hospital stay (14.90 ± 8/78 vs. 10.30 ± 6.78, p = 0.0016). No significant difference was observed in the time to bone union, surgical site complication incidence, and reoperation rates (p > 0.05). Flexion and flexion–extension knee ROM were demonstrated to be significantly improved in Group 2, 3, 6, and 12 months postoperatively (p < 0.0001). Conclusions: In this study, early ORIF and ciNPT use resulted in a shorter hospital length of stay, a reduced time to early active motion of the knee, and improved knee ROM. These results suggest that early ORIF with ciNPT for Schatzker type IV–VI TPFs is safe and effective in some patients. However, further research to confirm these findings across larger and more diverse populations is needed.

Aims Our objective was to conduct a systematic review and meta-analysis, to establish whether differences arise in clinical outcomes between autologous and synthetic bone grafts in the operative management of tibial plateau fractures. Methods A structured search of MEDLINE, EMBASE, the online archives of Bone & Joint Publishing, and CENTRAL databases from inception until 28 July 2021 was performed. Randomized, controlled, clinical trials that compared autologous and synthetic bone grafts in tibial plateau fractures were included. Preclinical studies, clinical studies in paediatric patients, pathological fractures, fracture nonunion, or chondral defects were excluded. Outcome data were assessed using the Risk of Bias 2 (ROB2) framework and synthesized in random-effect meta-analysis. The Preferred Reported Items for Systematic Review and Meta-Analyses guidance was followed throughout. Results Six studies involving 353 fractures were identified from 3,078 records. Following ROB2 assessment, five studies (representing 338 fractures) were appropriate for meta-analysis. Primary outcomes showed non-significant reductions in articular depression at immediate postoperative (mean difference -0.45 mm, p = 0.25, 95%confidence interval (CI) -1.21 to 0.31, I2 = 0%) and long-term (> six months, standard mean difference -0.56, p = 0.09, 95% CI -1.20 to 0.08, I2 = 73%) follow-up in synthetic bone grafts. Secondary outcomes included mechanical alignment, limb functionality, and defect site pain at long-term follow-up, perioperative blood loss, duration of surgery, occurrence of surgical site infections, and secondary surgery. Mean blood loss was lower (90.08 ml, p < 0.001, 95% CI 41.49 to 138.67) and surgery was shorter (16.17 minutes, p = 0.04, 95% CI 0.39 to 31.94) in synthetic treatment groups. All other secondary measures were statistically comparable. Conclusion All studies reported similar methodologies and patient populations; however, imprecision may have arisen through performance variation. These findings supersede previous literature and indicate that, despite perceived biological advantages, autologous bone grafting does not demonstrate superiority to synthetic grafts. When selecting a void filler, surgeons should consider patient comorbidity, environmental and societal factors in provision, and perioperative and postoperative care provision. Cite this article: Bone Jt Open 2022;3(3):218–228.

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. [ABSTRACT FROM AUTHOR]

Ipsilateral patella and tibial plateau fractures represent an extremely rare injury pattern. They are seldom discussed in literature, with no frameworks for management being reported that we were able to find. We report our experience and management of such an injury, suffered by a 57-year-old female patient with good premorbid functional status, by direct trauma to the right knee. Preoperatively, she was managed in a knee splint to aid elevation and help control her pain. We undertook fixation of both the patella and tibia through a midline incision. Postoperatively, we used a hinged knee brace, initially locked in extension, to allow gradual flexion at two weekly follow-ups. She has suffered no postoperative complications thus far at three months. We hope to highlight a novel management plan for this rare and complex fracture pattern, for which no prior published management evidence exists. As such, we submit the key principles from which our operative plan was derived to aid in the management of such injuries in the future., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Damaraju et al.)

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. [ABSTRACT FROM AUTHOR]

Copyright of Der Radiologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background To systematically review all available studies of operatively treated proximal tibia fractures and to report the incidence of superficial or deep infection and subsequent outcomes. Methods A systematic review of the literature in Medline, Cochrane, Embase and GoogleScholar was conducted to identify studies with cohorts of patients with infection after surgical treatment of proximal tibia fractures. Studies were included according to predefined inclusion and exclusion criteria. The studies were analysed for methodological deficiencies and quality of outcome reporting based on the Level of Evidence (LOE) and Coleman Methodology Scoring (CMS.) Results In total 32 studies were included. There was heterogeneity between the studies, in terms of subject of the studies, outcome criteria, fracture type and classification, surgical techniques and length of follow-up. Therefore, no meta-analysis could be performed. The average CMS was 54.2 (range 36–75). The included studies were 25 case series (LOE IV), 6 were prospective cohort studies (LOE III) and one was a prospective randomized trial (LOE I). 203 (12.3%, range: 2.6–45.0%) infections occurred in the overall population (n = 2063). Those were divided into 129 deep infections and 74 superficial infections. Revision due to infection was reported in 29 studies, microbiological results in 6, respectively. 72 (55,8%) of 129 cases reporting outcome after deep infection had an unsatisfactory outcome with substantial limitations of the affected joint and leg. Conclusions Postoperative infections are a challenge, sometimes requiring several revisions and often with a worse outcome. Further studies with structured study protocols should be performed for a better understanding of risk factors to improve treatment outcomes.

Introduction: Updated three column fixation of tibial plateau fractures (TPFs) arouse the importance of posterior column articular reduction. Complex TPFs with posterolateral (PL) articular injury is difficult to manage. We presented a strategy of combined positions and approaches to treat these injuries. Surgical technique was described and outcome of these were reported.Materials and Methods: From 2014 Jan to 2016 Dec, there were 132 patients of TPFs treated in our institute. Preoperative evaluation included plain films and 2D/3D CT scan to evaluate the involvement of articular surface and associated columns. Inclusion criteria were three column TPFs with PL corner injury. We put patients in prone position first with reverse L incision to manage PL articular impaction and posteromedial (PM) fractures. Then we repositioned the patients in supine to treat anterolateral fixation. Postoperative radiographic analysis, physical examination findings, and patient reported outcome scores from the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire were recorded.Results: Patient demographic information was retrospectively reviewed with a mean follow-up time of 34.4 months (range 24-48 months). The average time to union was 5.2 months (range 4-8months). 13/16 (81%) of patients had satisfactory articular reduction by plain films (less than 2 mm articular step off). All patients demonstrated healed without secondary displacement or infection. All patients demonstrated satisfactory coronal (medial proximal tibia angle 84.68 degrees) and sagittal alignment (posterior proximal tibia angle 84.75 degrees). Condylar width averaged 3.93 mm. 3/16 (19%) of cases required posterolateral columnar plating in addition to posteromedial columnar plating. The knee range of motion averaged 115 degrees (ranged from 0 degrees of extension to140 degrees flexion). The average KOOS score was 83/100 (range 76-90). 3 patients in the series developed a surgical site superficial infection and resolved after debridement and oral antibiotics use. No patient eventually received total knee arthroplasty at the last follow up.Conclusions: Our strategy provides an effective method to treat three column tibial plateau fractures with PL articular injury. [ABSTRACT FROM AUTHOR]

Exposure of a tibial plateau fracture involving the posterolateral quadrant is challenging, and several approaches for treating these fractures have been introduced. However, these approaches may have limited applicability, and they can potentially cause neurovascular, musculotendinous, or ligamentous injury of the posterolateral corner. Lateral femoral epicondylar osteotomy has been used for meniscal transplantation, total knee arthroplasty, and the treatment of posterolateral articular disorders of the femur and tibia. We encountered a case of a tibial plateau fracture involving the posterolateral quadrant without an anterior-extending fracture line. We successfully exposed, reduced, and fixed the fracture using combined lateral femoral epicondylar osteotomy and a submeniscal approach. This combined modality can be used as an alternative surgical technique for the treatment of tibial plateau fractures involving the posterolateral quadrant. [ABSTRACT FROM AUTHOR]

If not treated adequately, tibia plateau fractures result in premature osteoarthritis and lifelong disability. The advent of newer implants and techniques to improve outcomes has necessitated the development of different surgical approaches. A Medline and EMBASE search (June 2020) was conducted to identify publications during the last 10 years that focused on surgical approaches for proximal tibia fractures/ tibia plateau management. A total of 2107123 and 2715399 articles were found related to fractures in this area with 133 and 103 review articles looking at the approach on MEDLINE and EMBASE, respectively. This article reviews the continued development of the surgical approaches to aid understanding for surgeons and identify areas for future research to help improve outcomes. Although the anterolateral approach is the most commonly applied surgical technique, having the knowledge of newer approaches (medial, posteromedial, posterolateral, or direct posterior) in the armamentarium is necessary to treat the vast array of fracture patterns. There has been a shift amongst trauma surgeons of using a combination of approaches for complex tibia plateau fractures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sidhu et al.)

Abstract: Persistent pain and periprosthetic fracture of the proximal tibia are troublesome complications in modern unicondylar knee arthroplasty (UKA). Surgical errors and acute corners on the resected surface can place excessive strains on the bone, leading to bone degeneration. This study attempted to lower strains by altering the orthogonal geometry and avoiding extended vertical saw cuts. Finite element models were utilized to predict biomechanical behavior and were subsequently compared against experimental data. On the resected surface of the extended saw cut model, the greatest strains showed a 50% increase over a standard implant; conversely, the strains decreased by 40% for the radial-corner shaped model. For all UKA models, the peak strains below the resection level increased by 40% relative to an intact tibia. There was no significant difference among the implanted models. This study demonstrated that a large increase in strains arises on the tibial plateau to resist a cantilever-like bending moment following UKA. Surgical errors generally weaken the tibial support and increase the risk of fractures. This study provides guidance on altering the orthogonal geometry into a radial-shape to reduce strains and avoid degenerative remodeling. Furthermore, it could be expected that predrilling a posteriorly sloped tunnel through the tibia prior to cutting could achieve greater accuracy in surgical preparations. [Copyright &y& Elsevier]

Abstract: Background: Complex tibial plateau fractures can be difficult to characterise on plain radiographs and two-dimensional computed tomography (2D CT). The present study evaluated whether three-dimensional computed tomography (3D CT) reconstructions can improve the reliability of complex tibial plateau fracture characterisation and classification. Methods: Forty-five consecutive intra-articular fractures of the tibial plateau were evaluated by six independent observers for classification according to standard systems and for the presence of six characteristics: (1) posteromedial shear fracture; (2) coronal plane fracture; (3) lateral condylar impaction; (4) medial condylar impaction; (5) tibial spine involvement; and (6) separation of tibial tubercle necessitating fixation. Two rounds of characterisation and classification were performed: the first classification after a combination of plain radiographs and 2D CT and the second one after 3D CT information were added. Results: 3D CT improved the average ‘inter’-observer reliability of the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification (κ2D=0.536, 95% confidence interval (CI): 0.481–0.591 vs. κ3D=0.545, 95% CI: 0.478–0.612), the Hohl and Moore classification (κ2D=0.668, 95% CI: 0.605–0.732 vs. κ3D=0.746, 95% CI: 0.605–0.732) and of the Schatzker classification (κ2D=0.545, 95% CI: 0.494–0.596 vs. κ3D=0.596, 95% CI: 0.538–0.654). ‘Intra’-observer reliability also improved non-significantly for all systems after the addition of 3D CT for individual observers. 3D CT did improve the ‘intra’-observer reliability for the identification of the following fracture characteristics: coronal plane fracture (average κ2D=0.700, interquartile range (IQR): 0.551–0.820 vs. average κ3D=0.774, IQR: 0.692–0.847); lateral condylar impaction (average, κ2D=IQR: 0.675–0.901 to 1.000 vs. average, κ3D=0.785, IQR 0.737–0.807); medial condylar impaction (average κ2D=0.631, IQR: 0.537–0.670 vs. κ3D=0.719, IQR: 0.679–0.895); tibial spine involvement average (κ2D=0.621, IQR 0.545–0.678 vs. average κ3D=0.705, IQR: 0.652–0.794); separation of tibial tubercle necessitating fixation (average κ2D=0.332, IQR: 0.080–0.574 vs. average κ3D=0.441, IQR: 0.325–0.681). The only improvement that was found to be statistically significant was for recognition of medial condylar impaction as the IQR did not overlap. 3D CT had limited influence on average ‘inter’-observer reliability for the recognition of all specific fracture characteristics (κ2D=0.488 vs. κ3D=0.485, both moderate agreement for all fracture characteristics) but showed a non-significant improvement of the recognition of coronal plane fractures (fair to moderate; κ2D=0.398, 95% CI: 0.273–0.523 to κ3D=0.418, 95% CI: 0.262–0.574) and recognition of impaction of the lateral condyle (κ2D=0.614, 95% CI: 0.467–0.760 to κ3D=0.693, 95% CI: 0.538–0.849). Conclusions: The added value of 3D CT after 2D CT is limited and does not significantly improve reliability of characterisation and classification of tibial plateau fractures. [Copyright &y& Elsevier]

Progression to osteoarthritis (OA) is a frequent sequela of severe articular fracture, particularly when weight-bearing joints are involved. Prevention from post-traumatic OA remains a challenge. Hyaluronan (HA) therapy is reported to represent a safe and effective treatment for patients with OA and rheumatoid arthritis. However, the capacity of HA to prevent the occurrence of osteoarthritic changes in fractured joints has not been demonstrated. The present study was undertaken to examine the effects of HA on expression of six OA-related proteins in fibroblast-like synoviocytes (FLS) from 10 patients with tibia plateau fracture. OA-related factors were quantified using a sandwich enzyme-linked immunosorbent assay. Regardless of induction of the FLS with interleukin (IL)-1β, HA was found to down-regulate expression of catabolic factors (IL-1β, matrix metalloproteinase-3, and tumor necrosis factor-α) and to up-regulate production of anti-catabolic factors (tissue inhibitors of metalloproteinase-1 and metalloproteinase-2). HA also enhanced expression of IL-10, an anti-inflammatory cytokine, in FLS. Our results indicated that HA can promote the expression of both antiinflammatory and structure-protective factors in FLS of patients with tibia plateau fracture. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:495-500, 2011 [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The treatment of proximal tibial fractures is often challenging, and internal fixation is occasionally associated with problems in wound healing due to frequently co-existing soft tissue injuries. External fixation of these fractures have yielded satisfactory results, but some studies have reported problems in the achievement and maintenance of fracture reduction. The purpose of the present study was to evaluate the performance of a hybrid external fixator in the treatment of different types of proximal tibial fractures. Thirty-three proximal tibial fractures, of which 20 were high energetic, were treated with a hybrid external fixator (Tenxor® Strker-Howmedica) in the acute phase. Fracture categorisation was done according to AO/ASIF, and the reduction was performed most often by closed means or through mini-open reduction (26/78.8%). The patients were followed up to an average of 12.7 months (range 10–22) and were evaluated with radiographs and clinical examinations. Five AO/ASIF type-C intraarticular fractures had a poor postoperative reduction, and were thus treated with internal fixation in a second operation. Of the remaining 28 patients, local and transient pin tract infection was observed in seven patients, and one had septic arthritis of the knee. All 13 C1 and five of six C2/C3 fractures united in mean time of 15.1 weeks, whereas three of nine type-A fractures failed to unite, albeit an adequate reduction, and needed a second operation (odds ratio 11.4, 95% CI 1.0–143, compared with type-C fractures). For the remaining six type-A fractures, the mean healing time was 24 weeks (mean difference 8.9, 95% CI 6–12 weeks compared with type-C fractures). Age over 48 and the presence of an open fracture, but not fracture type, gender, or the level of injury energy, correlated to a poor subjective outcome. The hybrid external fixation method we have used is safe, and type-C1 fractures are particularly suitable to be treated with this method. However, even C2/C3 fractures may be candidates for this method, but a meticulous fracture reduction should be performed. Type-A fractures are liable to healing problems when the fixator is used as a rigid complex. [ABSTRACT FROM AUTHOR]

The goal of the current study was to determine the 15-year outcomes of 62 patients who underwent a total knee arthroplasty (TKA) after a prior tibial plateau fracture. Mean age at the index surgical intervention was 63 years. At most recent followup, there were 11 revisions. The 15-year survivorship free from revision for aseptic loosening was 96%. In unrevised cases, the components were radiographically well-fixed. There were a total of 21 complications, 90% of which occurred at <2 years. While patients undergoing TKA after a tibial plateau fracture have an increased rate of complications, the 15-year results indicate that subsequent survivorship is similar to that of patients undergoing TKA for degenerative arthritis if early complications can be avoided. [ABSTRACT FROM AUTHOR]

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Fifty-five patients who presented with the complaint of tibia plateau fractures between January 1998 and November 2001 were retrospectively evaluated. The evaluation was based on their treatment modality. Twenty-five conservatively-treated patients (group 1) and 30 surgically-treated patients (group 2) were evaluated. In group 1, seven patients with proximal fibula fractures had lateral hamstring tightness. Five out of these seven patients had concomitant lateral knee pain. Similarly, nine patients with proximal fibula fractures in group 2 had lateral hamstring tightness, and seven patients in the same group suffered from lateral knee pain. The patients with no fibula proximal fracture in both groups had no hamstring tightness or lateral knee pain. The proximal fibula in the knee joint and its anatomical structures are of utmost importance for the anatomical integrity of the knee and its normal functions. The fibula has rich anatomical relations, some of which are important structures of the knee. These anatomical structures and the fibula provide stability of the knee joint and its functions as well as being an important mechanical support to the knee joint. Therefore, the knee joint will receive the negative effects from the pathologies of the bone or soft tissue that may occur in fibula fractures. [ABSTRACT FROM AUTHOR]

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Aims: Our objective was to conduct a systematic review and meta-analysis, to establish whether differences arise in clinical outcomes between autologous and synthetic bone grafts in the operative management of tibial plateau fractures., Methods: A structured search of MEDLINE, EMBASE, the online archives of Bone & Joint Publishing, and CENTRAL databases from inception until 28 July 2021 was performed. Randomized, controlled, clinical trials that compared autologous and synthetic bone grafts in tibial plateau fractures were included. Preclinical studies, clinical studies in paediatric patients, pathological fractures, fracture nonunion, or chondral defects were excluded. Outcome data were assessed using the Risk of Bias 2 (ROB2) framework and synthesized in random-effect meta-analysis. The Preferred Reported Items for Systematic Review and Meta-Analyses guidance was followed throughout., Results: Six studies involving 353 fractures were identified from 3,078 records. Following ROB2 assessment, five studies (representing 338 fractures) were appropriate for meta-analysis. Primary outcomes showed non-significant reductions in articular depression at immediate postoperative (mean difference -0.45 mm, p = 0.25, 95%confidence interval (CI) -1.21 to 0.31, I 2 = 0%) and long-term (> six months, standard mean difference -0.56, p = 0.09, 95% CI -1.20 to 0.08, I 2 = 73%) follow-up in synthetic bone grafts. Secondary outcomes included mechanical alignment, limb functionality, and defect site pain at long-term follow-up, perioperative blood loss, duration of surgery, occurrence of surgical site infections, and secondary surgery. Mean blood loss was lower (90.08 ml, p < 0.001, 95% CI 41.49 to 138.67) and surgery was shorter (16.17 minutes, p = 0.04, 95% CI 0.39 to 31.94) in synthetic treatment groups. All other secondary measures were statistically comparable., Conclusion: All studies reported similar methodologies and patient populations; however, imprecision may have arisen through performance variation. These findings supersede previous literature and indicate that, despite perceived biological advantages, autologous bone grafting does not demonstrate superiority to synthetic grafts. When selecting a void filler, surgeons should consider patient comorbidity, environmental and societal factors in provision, and perioperative and postoperative care provision. Cite this article: Bone Jt Open  2022;3(3):218-228.

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 t -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 ( p = < 0.001 ) and AAAs ( p = 0.031 ). Furthermore, statistically significant differences in segmentation time were found between PISP and D2P for segmentations of AAAs ( p = 0.008 ). 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., (© 2021 Society of Photo-Optical Instrumentation Engineers (SPIE).)

Abstract: A 48-year-old Chinese woman was hit by a car in a road traffic accident. Local county hospital considered that her right knee was injured, but didn’t find any sign of fracture from X-ray imaging. Then the hospital gave diagnosis of soft tissue contusion and the patient started to exercise with burden 21 days after her right lower limb was fixed by plaster slab. Four months later, she had to go back to the county hospital for recheck due to persistent pain on her right knee. Then, the right tibia outer plateau fracture was found. The patient rejected the advice of open reduction and internal fixation of right tibia plateau fracture. Instead, she accepted the unicompartmental knee arthroplasty in a hospital affiliated to a medical college. The patient felt the knee pain alleviated after surgery However, the joint dysfunction was aggravated even more. The patient used the legal procedure for personal compensation. Both driver and the insurance company disputed that the final consequence of the injured knee was due to not only the traffic accident, but also poor medical practice involved. Therefore the court consigned us to make judicial judgment of expertise. After investigation, we found the earliest X-ray graph after the accident had shown the fracture of right tibia outer plateau and right knee valgum, with articular surface involvement, andthe traffic accident was considered as the primary cause of sequelae. At the same time, the county hospital missed the diagnosis of fracture, and led to insufficient fixation of right lower limb, which was not good for rehabilitation from fracture and joint injury. This was the secondary cause of sequelae. Additionally, instead of the standard therapy, the affiliated hospital of medical college made the unicompartmental knee arthroplasty four months later, which also had a little defect. It was the minor reason for the result. [Copyright &y& Elsevier]