Abstract
The treatment of the complex tibial plateau fractures is often hard because in these fractures, the entity of the articular damage is always important, the reduction is not easy it entails often extensive exposure and the collapse of the metaphyseal bone, located beneath the reconstructed articular surface, makes the osteosynthesis mechanically unsafe for ten or twelve weeks. The percutaneus surgical treatment, let us reach three fundamental objectives: to be mini-invasive, to result in a good reduction, to have a stable fixation. Through a small skin incision at the metaphysis, a leever was inserted across a small door made on the cortical metaphiseal bone and the articular fragments were elevated and held in the reduced position. Temporarily the fragments were fixed with a Kirshner-wire and definitely fixed with one or more canulated screw NORIAN S.R.S, used to fill the bone gap resulted from the traumatic collapse of the metaphyseal bone, with its initial mechanical strenghth allows to stabilize the joint fragments reduction and the relative ostheosyntesis, thus shortening the functional recovery time. Since 1997 we operated 52 patients affected by tibial plateau fractures using this percutaneus technique with the application of the mineral bone substitute Norian. 42 fractures were unicondylar: 16 type B2 and 26 Type B3 according to AO classificaction; 10 fractures were bicondylar 4 type C2 and 6 type C3 AO classificaction. The minimum follow-up was 1 year. We used for clinical evaluation 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-rays data, can be simplified and represented as follows: 26 cases can be considered excellent that is (50%), 12 good (23%), 10 fair (20%), and 4 poor (7%). In conclusion we can say that Norian offers a real advantage in displaced tibial plateau fractures, because it is an unlimited supply of bone substitute, an optimal filling for the irregular defects of the cancellous bone and because it gives an immediate mechanical support to the joint, integrating the percutaneous ostheosynthesis perfectly. It is an important improvement in order to cut down the functional recovery time with great benefit for patients.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
