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COMMENTARY |
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Year : 2013 | Volume
: 6
| Issue : 1 | Page : 41-42 |
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Tibial plateau fractures
Samar K Biswas, Ajit Swamy
Department of Orthopaedics, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
Date of Web Publication | 14-Mar-2013 |
Correspondence Address: Samar K Biswas Department of Orthopaedics, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune India
Source of Support: None, Conflict of Interest: None | Check |
How to cite this article: Biswas SK, Swamy A. Tibial plateau fractures. Med J DY Patil Univ 2013;6:41-2 |
The knee joint is synonymous with mobility and agility. The knee is a vital link in the kinetic chain of the body, but it is also exposed to the risks of our fast-paced life.It is prone to direct injuries and accidents.The present issue includes a couple of articles ontibial plateau fractures.
Tibial plateau fractures were originally called 'bumper' or 'fender' fractures because they resulted from low-energy pedestrian versus car bumper accidents. However, the majority of tibial plateau fractures reported in the recent literature have resulted from high-speed motor vehicle accidents and falls from a height. [1],[2] Fractures of the tibial plateau are caused by direct axial compression usually with a valgus or varus moment and indirect shear forces.
The challenges which an orthopedic surgeon is exposed to include immediate injury to neurovascular structures, skin loss, and delayed arthritic changes.Although Hohl's classification [3] was the first widely accepted description of tibial plateau fractures, Schatzker's classification [4] is currently the most widely used and he was the first to make a distinction between medial and lateral plateau fractures.
The exact indications for surgical intervention vary widely in the literature. [5],[6],[7] The degree of articular depression that can be accepted ranges from 2 mm to 1 cm. [8],[9] Majority consider an offset of more than 5 mm unacceptable. Associated neurovascular complications require urgent operative intervention.
The operative techniques include medial, lateral, or bicondylar plating with or without bone graftingand unicondylar plating with external fixation. The current focus is on arthroscopy-assisted articular reconstruction with UMEX (UMEX: universal mini external fixator) application for minimally invasive surgery.
Every case should be judged on its merit.It is imperative for the orthopedic surgeon to know when to-and especially when not to-operate,especially in elderly osteoporotic fractures. The guidelines are written and established; yet, it is and will continue to be an art to treat this rather difficult fracture of the knee. It is the clinical acumen and experience of the treating surgeon which will prove to be the saviour of not only the patient but of the surgeon also.
References | | |
1. | Burri C, Batzke G, Coldewy J, Muggler E. Fractures of the tibial plateau. Clin Orthop Relat Res 1979;138:84-93. |
2. | Honkonen SE, Jarvivin MJ. Classification of fractures of the tibial condyles. J Bone Joint Surg Br 1992;74:840-7. |
3. | Hohl M. Tibial condylar fractures. J Bone Joint Surg Am 1967;49:1455-67. [PUBMED] |
4. | Schatzker J, McBroom R, Bruce D. The tibial plateau fracture: The tibial experience 1968-1975. Clin Orthop Relat Res 1979:94- 104. [PUBMED] |
5. | DeCoster TA, Nepola JV, el-Khoury GY. Cast brace treatment of proximal tibial fractures: A ten year follow up study. Clin Orthop Relat Res 1988:196-204. [PUBMED] |
6. | Dewilius PJ, Connolly JF. Closed reduction of tibial plateau fractures: A comparision of functional and roentenographic end results. Clin Orthop Relat Res 1988:116-26. |
7. | Schatzker J. Fractures of the tibial plateau. In: Schatzker J, Tile M, editors. The rationale of operative fracture care. Berlin: Springer-Verlag; 1987. p. 279. |
8. | Hohl M, Luck JV. Fractures of the tibial condyle: A clinical and experimental study. J Bone Joint Surg Am 1956;38-A:1001-18. [PUBMED] |
9. | Rassmussen PS. Tibial condylar fractures: Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 1973;55:1331-50. |
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