ARTHROSCOPICALLY ASSISTED REDUCTION AND INTERNAL FIXATION OF TIBIAL PLATEAU FRACTURES

Abstract

PURPOSE OF THE STUDY: Arthroscopic assisted treatment of tibial plateau fractures may reduce morbidity compared to open articular surgery, but bony fixation is necessarily percutaneous and minimal. The purpose of our study was not only to assess immediate results but also long term functional and anatomic results after arthroscopic treatment of tibial plateau fractures, with special reference to radiographical Results:

MATERIAL AND METHODS: seventy patients (mean age 47 years, range 18 to 72 years, 43 men, 27 women) were arthroscopically assisted treated for a fresh tibial plateau fracture. According to Schatzker classification, there was 20 type I, 27 type II, 18 type III and 5 type IV. The fixation device was: Kirchner wire in Schatzker I, percutaneous cannulated screw in Schatzker II,III,IV, and bone cement filing of the fracture site in 1 case. In 32 cases, where bone loss was significant. we use autologous bone graft, in 18 cases SRS. There were 15 meniscal injuries: 3 underwent arthroscopic suture, 8 had partial meniscectomy and 4 sub subtotal meniscectomy. We also diagnosticated 7 lesions of the medial pivot 6 ACL, 1 PCL : all were left in place. Al patients in the first post-operatory day start passive rehabilitation with kinetech All cases were suitable for immediate post op follow up. 19 were reviewed at long term. A clinical (Hospital for Special Surgery) and radiographical examination were done with an average follow-up of 46.7 months.

RESULTS: There were no complications except two immediate compartimental syndromes that stopped the arthroscopic treatment. Passive motion of the knee started at 1 day postop with no pain. Mean flexion at 3 months was 130 degrees. At revision, the average score was: 93 for Schatker I, 91 for Schatker II, 87 for Schatker III, 86 for Schatker IV. In eight cases we found early signs of osteoarthritis. There were no secondary bony depression or significant valgus deformity on X-rays.

CONCLUSION: Arthroscopic management of tibial plateau fractures allows a complete articular screening. Rapid rehabilitation, short hospital stay, and low rate of complications reduce morbidity. The long term results are as good as those with open surgical technique for the types of fracture that we have treated (type III and IV). A minimal, percutaneous osteosynthesis which was the only possibility under arthroscopic control, did not modify the anatomical Results: