Controversies in the treatment of tibial plateau fractures

Markus Parkkinen

Tutkimustuotos: OpinnäyteVäitöskirjaArtikkelikokoelma

Abstrakti

Tibia plateau fractures are relatively uncommon, but they are among the most challenging intra-articular fractures to treat. These fractures can lead to early posttraumatic osteoarthritis (OA) and cause disability and constant pain. Currently, the most common treatment is open reduction and stable internal fixation (ORIF), allowing early mobilization of the knee. Tibial plateau fractures can be associated with several concomitant soft tissue injuries of the knee. Historically, the operativetreatment with internal fixation has also been related to an increased risk for serious wound complications. The purpose of this study was to investigate the current management and outcome of proximal tibia fractures. The study population consisted of various groups of patients with proximal tibia fractures treated between 2002 and 2013 at our level I trauma center. The study aimed to determine factors predicting the development of posttraumatic OA following tibial lateral or medial plateau fractures. Another focus was on the incidence of concomitant injuries after the most common lateral plateau fracture type and the need for MRI as a diagnostic tool when treating these fractures. Finally, the predictors for deep surgical site infection after plate fixation of proximal tibia fracture were examined. The results showed that relatively good functional outcome can be predicted after internal fixation of lateral and medial tibial plateau fractures. However, patients with lateral plateau fractures with residual depression of the articular surface >2 mm or valgus deformity >5° had significantly more severe (Kellgren-Lawrence grade 3–4) posttraumatic OA. The most significant predictor of posttraumatic OA after medial plateau fracture was the amount of initial depression of the articular surface measured from the preoperative computer tomography, while the quality of reduction was not found to predict OA. MRI had low sensitivity and specificity in the diagnosis of concomitant injuries in the lateral tibial plateau fracture setting. Also nearly all of the clinically relevant concomitant injuries could be treated through the same lateral arthrotomy at the time of ORIF without the need for additional arthroscopy. There is high morbidity associated with deep SSI in plated proximal tibial fractures. Patient’s age ≥50 years, obesity, history of alcohol abuse, and AO type C fracture are independent risk factors for infection. Performing a fasciotomy also increases the risk of deep infection and should be done with meticulous technique only when deemed necessary.
Alkuperäiskielienglanti
Valvoja/neuvonantaja
  • Madanat, Rami, Valvoja
  • Mäkinen, Tatu , Valvoja
Myöntöpäivämäärä12 tammikuuta 2018
JulkaisupaikkaHelsinki
Kustantaja
Painoksen ISBN978-951-51-3667-1
Sähköinen ISBN978-951-51-3668-8
TilaJulkaistu - 2018
OKM-julkaisutyyppiG5 Tohtorinväitöskirja (artikkeli)

Tieteenalat

  • 3126 Kirurgia, anestesiologia, tehohoito, radiologia

Siteeraa tätä

Parkkinen, M. (2018). Controversies in the treatment of tibial plateau fractures. Helsinki : [M. Parkkinen].