Arthroscopic assisted percutaneous bone grafting and screw fixation for the treatment of lateral tibial plateau fractures: A 4-year follow-up

doi:10.3969/j.issn.2095-4344.2013.26.009

Abstract

Abstract:

BACKGROUND: Studies have shown the knee secondary osteoarthritis may occur after the treatment of tibial plateau fractures with open reduction and internal fixation, but the researches on the middle- and long-term effect of arthroscopic assisted tibial plateau fracture fixation are still rare.
OBJECTIVE: To evaluate the outcomes of lateral tibial plateau fractures after treated with arthroscopic assisted percutaneous bone grafting and screw fixation for 1 and 4 years through clinical and radiological assessment.
METHODS: Between March 2007 and March 2009, with the information of the patients with lateral tibial plateau fractures undergoing arthroscopic assisted percutaneous bone grafting and screw fixation were enrolled. The data of the type of fractures in the Schatzker classification, the accompanying lesions of the cartilage defect on the lateral tibial plateau, the cartilage damage on the femoral condyle, intra-articular soft tissue lesions and insufficient reduction of the fracture, as well as postoperative subsidence in the lateral tibial plateau were collected. The Lysholm score, Ahlback osteoarthritis classification, Rasmussen function score and radiological score were assessed at 1 and 4 years after treated with percutaneous bone grafting and screw fixation.
RESULTS AND CONCLUSION: Twenty-three patients finished the follow-up. At 1 and 4 years after percutaneous bone grafting and screw fixation, the mean Lysholm score was 90 and 87 points respectively (P=0.23), and the mean Rasmussen function score was 26 and 24 points respectively (P=0.30). At 4 years after surgery, 11 cases (47.8%) presented osteoarthritis and the Rasmussen radiological score was decreased from early postoperative 17.4 points to 4-year postoperatively 13.6 points (P=0.01). No correlation could be observed between the various types of fractures and their prognosis. The elder cases, cartilage damage and/or defect, intra-articular soft tissue lesions and postoperative subsidence in the lateral tibial plateau were correlated with function and radiological middle outcomes after surgery. However, the cartilage defects on tibial plateau had minor effect on knee osteoarthritis when compared with cartilage damage on the femoral condyle. Early radiological outcomes do not completely consistent with that of the 4 years after surgery, but the medium-term clinical and functional follow-up outcomes are still satisfied. Age, cartilage damage or defect, intra-articular soft tissue lesions and postoperative subsidence in lateral tibial plateau appears as prognostic factors for osteoarthritis after treatment. The prognostic effect of cartilage defects on tibial plateau for osteoarthritis is lower than that of cartilage damage on the femoral condyle which may be attributed to integrated function of lateral meniscus.

Key words: bone and joint implants, orthopedic implants, clinical experiment of bone and joint, lateral tibial plateau, fracture, arthroscopy, percutaneous fixation, Lysholm score, Ahlback osteoarthritis classification, Rasmussen score

CLC Number:

R318

Zeng Run-ming, Wu Sheng-rong, Lin Shao-bin. Arthroscopic assisted percutaneous bone grafting and screw fixation for the treatment of lateral tibial plateau fractures: A 4-year follow-up[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.26.009.

Figures/Tables 4

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