Arthroscopic Assisted Intra-Articular Reduction and Internal Fixation of Tibia Plateau Fracture

Dong Hwi Kim; Gwang Chul Lee; Kwi Youn Choi; Sung Won Cho; Sang Ho Ha

doi:10.12671/jkfs.2013.26.3.191

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Kim, Lee, Choi, Cho, and Ha: Arthroscopic Assisted Intra-Articular Reduction and Internal Fixation of Tibia Plateau Fracture

Original Article

Journal of the Korean Fracture Society 2013; 26(3): 191-198.

Published online: 15 July 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.3.191

Arthroscopic Assisted Intra-Articular Reduction and Internal Fixation of Tibia Plateau Fracture

Dong Hwi Kim, M.D., Gwang Chul Lee, M.D., Kwi Youn Choi, M.D., Sung Won Cho, M.D., Sang Ho Ha, M.D.

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.

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: 82-62-220-3147, Fax: 82-62-226-3379, leekci@chosun.ac.kr

Received 29 January 2013 Revised 12 March 2013 Accepted 25 April 2013

(open-access):

This is anOpen 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.

Abstract

Purpose

We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts.

Materials and Methods

From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system.

Results

The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases.

Conclusion

We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.

Keywords: Knee joint, Tibial fracture, Arthroscopy

Figures and Tables

Fig. 1

A fragment interfering with the reduction is called a key fragment (short arrows). The landmark of the screw insertion site was fibular head and Gerdy's tubercle. Long arrows indicate direction of screw insertion.

Fig. 2

Arthroscopic findings See the depressed fracture fragment (A) and depressed fragment reduced by freer (B).

Fig. 3

Preoperative radiologic findings. Antero-posterior (AP) view (A) and computed tomography images (B) of the right knee of a 28-year-old male patient shows a depressed lateral tibial plateau fracture (Schatzker type II). Both AP and lateral view (C, D) of the right knee shows a complete fracture reduction and internal fixation using a cannulated screw without bone graft.

Fig. 4

Preoperative radiologic findings. Antero-posterior (AP) view (A) and computed tomography (CT) image (B) of the left knee of a 60-year-old male patient shows a tibia plateau fracture (Schatzker type V). Postoperative radiographic findings. AP view (C) and CT image (D) of the left knee shows an additional fixation by locking compression plate-proximal lateral tibia minimally invasive plate osteosynthesis (LCP-PLT) (MIPO technique).

Fig. 5

(A) Ten months after the operation, computed tomography images show a complete bone union with congruency of the articular surface. (B) Second look arthroscopy shows a healed articular surface as well as lateral meniscus.

Table 1

Patient Demographics (N=12)

M: Male, F: Female, LM: Lateral meniscus, MCL: Medial collateral ligament, PCL: Posterior cruciate ligament, MM: Medial meniscus, ACL: Anterior cruciate ligament.

Table 2

Results (N=12)

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