Retrospective Evaluation of the Results of Arthroscopy Assisted Reduction and Osteosynthesis of Tibial Plateau Fractures and the Role of the Arthroscopy at Tibial Plateau Fractures

摘要

Objectives: Aim of this study is to compare the medium and long term functional and radiological results of 31 patients with tibial plateau fractures, treated by same surgeon with arthroscopy assisted reduction and osteosynthesis between 2006 and 2013. Methods: This study is designed as evaluation of retrospective case series. 52 patients who has administered Tepecik Education and Research Hospital or Private Izmir Hospital between 2006 and 2013 with tibial plateau fracture and treated by same surgeon with arthroscopic assisted reduction and osteosynthesis is evaluated. Patients with insufficient data and cannot continue follow-up are excluded. 31 patient is included to study meeting our criteria. Injury mechanism, physical examination findings, operation records, concomitant intra articular pathologies, need for allograft or autograft and radiological investigations are retrospectively obtained from hospital medical record system. Preoperative evaluation depends on Schatzker Classification. Patients with floating knee, ipsilateral tibia diaphysis fracture, distal femoral intraarticular fracture, compartment syndrome or neurovascular injury is excluded from study. We didn’t take Schatzker Class is not an exclusion criteria. Results are investigated with Rasmussen radiological and clinical scores statistically. Results: 31 patients (23 male, 7 female) with mean age of 46,3 (min. 18- max. 67) is included our study with the mean follow-up of 45 months. Simultaneous meniscus lesion is detected in 15 patients and repair or partial meniscectomy is performed depending on the lesion. 10 patients need for allograft or autografting for joint surface restoration. Medial and/or lateral plate osteosynthesis is performed depending on fracture configuration. Final average Rasmussen functional score is calculated 25,7 and final average Rasmussen radiological score as 16,5. Secondary arthroscopic debridement is needed in 3 patients with arthrofibrosis. Conclusion: First arthroscopy assisted intra-articular fracture treatment is done in 1993 at knee joint and technique is improved with years. With the published satisfactory results of arthroscopy assisted series, current treatment of choice in tibial plateau fractures became arthroscopy assisted osteosynthesis, same as our routine application in our clinics. Advantages of arthroscopy is opportunity of treatment of concomitant intra articular pathologies, differentiation of these lesions as acute or degenerative and chronic more objective than any other imaging modality, detection of chondral injury more accurate and control of anatomical reduction of fracture lines. Downside of our study is lack of control group. Our conclusion is arthroscopy assistance in tibial plateau fractures improves results without increase in compartment syndrome or other complication rate when compared to literature.