Summary Statement

Preoperative bone-marrow-derived cell mobilization by G-CSF is a safe orthopaedic procedure and allows circulation in the blood of high numbers of CD34+ve cells, promoting osseointegration of a bone substitute.

This study reports the 5-year clinical and radiological outcomes of a simple arthroscopic-assisted technique for Schatzker type II and III tibial plateau fractures, without bone grafting. Forty six patients (46% males, 54% females, average age 48 years, SD 13.6 years), with tibial plateau fractures Schatzker type II (41%) and III (59%), underwent an arthroscopic-assisted technique conceived to use a compacted cancellous bone graft, taken from the medial metaphyseal side of the tibia, and a percutaneous fixation.

The patients were prospectively followed-up at one, three and five years from surgery. Independent assessments were carried out using Knee Society Score, HSS score and Rasmussen’s clinical and radiological scores. At 5-year follow-up patients underwent a weight-bearing radiograph of both limbs.

At last follow-up evaluation Knee Score (average 93.2, SD 7.7) was excellent in 37 patients (80%), good in six (13%), fair in three (7%). Function Score (average 94.8, SD 8.51) was excellent in 38 patients (83%), good in five (11%), fair in three (6%). HSS score (average 93.4, SD 8.23) was excellent in 41 patients (89%), good in five (11%). The average Rasmussen clinical score was 28.2 (SD 1.4). The radiological Rasmussen score was excellent in five patients (11%), good in 39 (85%) and fair in two (4%). In the weight-bearing radiographs a valgus deviation was present in four patients (8.7%).

Arthroscopic-assisted technique for lateral tibial plateau fractures without bone grafting has outcomes encouraging and comparable to the results of other techniques that use either iliac crest graft or bone substitutes.

Aims: Propose of this study is to evaluate the results of mini open surgical technique in treatment of tibial plateau fractures. Methods: Between September 1999 and September 2000, 10 patients (6 men, 4 women) with closed tibia plateau fractures were treated with arthroscopic and mini open surgical technique. The mean age was 48 (range 28–72 years). The mean follow-up was 26 months (range 20 months to 36 months). Schatzker classiþcation system was used for evaluation and classiþcation of the fracture patterns. Hence, three cases were type 1, four were type 2 and three cases were type 3. The arthroscopy was done in all the cases. No meniscus tears were found in all the patients. The plateau fracture has been reconstructed with elevation, through an antero-medial window in the proximal metaphysis of the tibia, with a particular carrot system. No autograft bone was adopted. We used a percutaneous þxation with AO cannulated screws (1–3 screws). Results: The results were evaluated with the HSS Knee Score System. There were no preoperative and postoperative complications. The results were 80% excellent, 20% good. The average of the Knee Score was 94 (range 78–100) and the average of the Functional Score was 96 (range 80–100). Conclusions: The arthroscopy and the mini open surgical technique create a complete anatomical reduction of articular fractured area with no graft.