Abstract
The treatment of complex tibial plateau fractures is often difficult because in these fractures the nature of the articular damage is always important, the reduction is not easy, often entailing extensive exposure, and the collapse of the metaphyseal bone, located beneath the reconstructed articular surface, makes the osteosynthesis mechanically unsafe for 10 or 12 weeks.
There are three fundamental objectives of percutaneous surgical treatment: to be minimally invasive, to result in a good reduction and to achieve stable fixation. Through a small skin incision at the metaphysis, a leever was inserted across a small door made on the cortical metaphyseal bone and the articular fragments were elevated and held in the reduced position. Temporarily the fragments were fixed with a Kirschner wire and definitely fixed with one or more cannulated screws. Norian S.R.S was used to fill the bone gap that resulted from the traumatic collapse of the metaphyseal bone: with its initial mechanical strength the joint fragment reduction and the developing ostheosynthesis can be stabilised, thus shortening the functional recovery time.
Between 1997 and 2002 we operated 52 patients with tibial plateau fractures using this percutaneous technique and application of the mineral bone substitute Norian. Of these, 42 fractures were unicondylar, 16 type B2 and 26 Type B3 according to the AO classification, and 10 fractures bicondylar 4 type C2 and 6 type C3 according to the AO classification. The minimum follow-up was 1 year. For clinical evaluation we used the Hohl assessment form, for the radiographs the criteria of Rasmussen X-rays. The final conclusions, resulting from integrated analysis of the clinical data and X-ray data, can be simplified and represented as follows: 26 cases can be considered excellent (50%), 12 good (23%), 11 fair (21 %) and three poor (6%).
In conclusion, Norian offers a real advantage in the treatment of displaced tibial plateau fractures, because it offers an unlimited supply of bone substitute, is an optimal filling for the irregular defects of the cancellous bone and gives immediate mechanical support to the joint, integrating the ostheosynthesis perfectly. The recostruction of the tibial plateau with minimally invasive surgery such as percutaneous indirect reduction by elevation and percutaneous osteosynthesis, with mechanical stability assured by Norian SRS, is an important improvement. The functional recovery time is reduced, with great benefit for patients.
