The medial approach for arthroscopic-assisted fixation of lateral tibial plateau fractures

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dc.authorscopusid6602951871
dc.authorscopusid56469094900
dc.authorscopusid6603096694
dc.authorscopusid55308015700
dc.authorscopusid59071673200
dc.contributor.authorElmali N.
dc.contributor.authorBaysal Ö.
dc.contributor.authorKarakaplan M.
dc.contributor.authorGülabi D.
dc.contributor.authorSağlam F.
dc.date.accessioned2024-08-04T20:03:39Z
dc.date.available2024-08-04T20:03:39Z
dc.date.issued2014
dc.departmentİnönü Üniversitesien_US
dc.description.abstractObjectives: Tibial plateau fractures are complex injuries involving the weight bearing surface of the tibia. Open reduction and internal fixation with plates and screws is an established method of treatment for complex fractures (Schatzker types V–VI). Arthroscopically assisted techniques have been used successfully for simple fractures (Schatzker types I–III). Historically, arthroscopic-assisted reduction for lateral tibial plateau fractures have been performed through a laterally based metaphyseal window. We found this technique to have several limitations, including bone grafting through a short subchondral tunnel. Also, there was a risk of lateral vascular supply distrubtion. We proposed that medial window approach technique would provide a longer tunnel for subchondral support and aid in fracture reduction. We aimed to present our initial experiences in first seven cases approaching lateral tibial plateau fractures through a medial metaphyseal window. Methods: Our series involves 7 patients with 5 Schatzker type II and 2 Schatzker type III lateral tibial plateau fractures treated by a single surgeon, using a medial approach for the arthroscopic assisted fixation. There were 5 males and 2 females. The average age at the time of surgery was 34.2 years, (29-52). All of the patients underwent plain radiography and CT scanning in each knee Time from injury to surgery was 7.2 days (4-12 days). Length of follow up was 9 months (6-22 months). There was 2 lateral meniscus tear that treated with partial meniscectomy and 1 MCL injury that treated conservativeely. Surgery was performed in four steps. First step was diagnostic arthroscopy of the injured knee,, second step was reduction of the fracture using a sylindiric tube with fluoroscopic guidance, third step was the arthroscopic verification of the fracture reduction, and finally percutaneous osteosynthesis of the fracture.Care is taken to keep the flow to gravity or, if using a pressure controlled pump, to set the pressure at approximately 40 millimeters of mercury. This will help alleviate the risk of compartment syndrome. Compartment firmness should be continuously monitored throughout the procedure. Results: No complications related to the procedure were observed. All patients reported a relevant reduction in pain, were able to mobilize with full weight bearing in the average 12 weeks (9–15 weeks). No secondary loss of reduction was observed in radiological controls; No revision surgery was required. Functional assessment according to HSS (hospital for special surgery) of the patients were excellent in 5 cases, good in 2 cases. Conclusion: Because depressed fragments are elevated from distal cortical windows, the importance of an intact, or easily restored, “cortical envelope” is paramount. In most Schatzker Type II and III fractures, the cortical envelope is either intact or can easily be restored with a clamp. The main advantage of medial approach for these fracture patterns is the creation of a long tunnel for subchondral support, the ease of fracture reduction and saving the lateral vascular supply. © The Author(s) 2014.en_US
dc.identifier.doi10.1177/2325967114S00219
dc.identifier.issn2325-9671
dc.identifier.issue11en_US
dc.identifier.scopus2-s2.0-85000774305en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.urihttps://doi.org/10.1177/2325967114S00219
dc.identifier.urihttps://hdl.handle.net/11616/91991
dc.identifier.volume2en_US
dc.indekslendigikaynakScopusen_US
dc.language.isoenen_US
dc.publisherSAGE Publications Ltden_US
dc.relation.ispartofOrthopaedic Journal of Sports Medicineen_US
dc.relation.publicationcategoryDiğeren_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectmercuryen_US
dc.subjectarthroscopic surgeryen_US
dc.subjectclinical articleen_US
dc.subjectcompartment syndromeen_US
dc.subjectfluoroscopyen_US
dc.subjectfracture fixationen_US
dc.subjectfracture reductionen_US
dc.subjectfunctional assessmenten_US
dc.subjecthumanen_US
dc.subjectknee injuryen_US
dc.subjectknee meniscus ruptureen_US
dc.subjectmeniscectomyen_US
dc.subjectNoteen_US
dc.subjectosteosynthesisen_US
dc.subjectoutcome assessmenten_US
dc.subjectpriority journalen_US
dc.subjectsurgical approachen_US
dc.subjecttibia fractureen_US
dc.subjecttibial plateau fractureen_US
dc.subjecttreatment outcomeen_US
dc.titleThe medial approach for arthroscopic-assisted fixation of lateral tibial plateau fracturesen_US
dc.typeNoteen_US

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