THE ROLE OF PREOPERATIVE AND POSTOPERATIVE COMPUTED TOMOGRAPHY SCAN FOR TIBIA PLATEAU FRACTURES TREADED WITH MINIMAL INVASIVE TECHNIQUE

Abstract

Aim: To evaluate the long term results of the combined treatment of hybrid external fixator and limited internal fixation along with the advantages using pre-operative and post-operative computed tomography scan in these cases.

Material and Methods: During a period of 12 months, 16 fractures of tibial plateau, were treated in 16 patients. Fractures were classified according to Schatzker’s staging system as type II 2 cases, type III 4 cases, type IV 3 cases, type V 4 cases, type VI 3 cases. Eleven patients were men and 5 women with a mean age of 42 years old (27–67 years). In all cases pre-operatively were programmed coronal and saggital reconstructed CT-Scan, revealed the precise location and degree of articular comminution and joint depression. The principles of ligamentotaxis was used to achieve the closed indirect reduction, and limited open reduction with internal fixation was performed in 9 patients. All cases were treated with hybrid external fixators. After the removal of the plants, CT-Scan was programmed for all the cases.

Results: All patients were evaluated with a mean period of follow up 1.9 years. Healing was achieved in all 16 cases with a mean period of 16 weeks. There was no non-union. Pin tract infection occurred in two cases. Two fractures developed a malunion (1 valgus deformity and 1 anterior angular deformity). Radiographic evidence of arthritis appeared in 2 patients during follow up. CT-Scan offer us the possibility to measure precious the sinking of the tibia plateau in degrees, the condylar widening in mm, the degeneration of joint space, the varus-valgus tilt in degrees, the articular step-off in mm and the bone healing. Based to post-operative CT-Scan information we can organize a safe rehabilitation program and aloud the full bear-weight in the perfect time.

Conclusions: The use of circular external fixators obtains good stabilization allows early joint motion, protects soft tissue envelope and in combination with minimal internal fixation on achieves satisfactory reduction. It is almost impossible to measure sinking of the tibia plateau since plain radiographs do not distinguish between a local defect and depression of the condyles. The pre-operative CT-Scan assists in the pre-operative management. The post-operative CT-Scan shows important information about bone healing. Postoperative radiographs may have led to an underestimation of the degree of residual displacement. On the contrary, CT-Scan demonstrates the exact grade of articular displacement and depending on CT-Scan results one can better manage the post-operative rehabilitation.