Arthroscopic Assisted Reduction and Internal Fixation of Tibial Plateau Fractures.

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Abstract

18. J Orthop Case Rep. 2024 Dec;14(12):277-282. doi: 10.13107/jocr.2024.v14.i12.5096. Arthroscopic Assisted Reduction and Fixation in Tibial Plateau Fractures: A Prospective Review. Patil V(1), Shah M(1), Nair V(1), Mohammed T(1), Todkar A(1), Ugile S(1). Author information: (1)Department of Orthopaedics, Dr. D.Y. Patil Medical College Hospital and Research Institute, Pimpri-Chinchwad, Maharashtra, India. INTRODUCTION: Tibial plateau fractures, which constitute approximately 1% of all fractures with an incidence of 10.3/100,000 annually, result from varus or valgus forces combined with axial loading in the knee. These fractures display a bimodal distribution, affecting younger individuals through high-velocity trauma and older individuals through low-energy trauma. Proper management is critical due to the tibial plateau's role as a load-bearing surface; inadequate treatment can lead to functional impairment and early osteoarthritis. Utilizing the Schatzker classification, this study categorizes tibial plateau fractures to streamline treatment and reproducibility. OBJECTIVES: The objective of the study was to assess the functional and radiological outcomes in the patients operated with arthroscopic assisted reduction and internal fixation (ARIF). MATERIALS AND METHODS: This prospective analytical study conducted at a tertiary care hospital evaluates the functional and radiographic outcomes of 20 patients with Schatzker Type 1-4 tibial plateau fractures treated using ARIF. Patients excluded were those with Schatzker Type 5 and 6 fractures due to the increased risk of compartment syndrome from fluid extravasation during arthroscopy. Surgical procedures aimed to achieve anatomical reduction, proper alignment, stable fixation, early mobilization, and minimal soft-tissue damage. RESULTS: The study conducted in the cohort which constituted of 20 patients with a mean age of 44.3 years with 9 males and 11 females and fracture distribution being Schatzker 1/2/3/4: 3/5/10/2, respectively, found ARIF advantageous in diagnosing and treating articular cartilage and soft-tissue injuries, minimizing soft-tissue dissection, and reducing the need for extensive arthrotomy. The results demonstrated good to excellent outcomes in 85% of patients, with no depression in 70% of cases and no varus/valgus malalignment in 80% of cases after 18 months. However, the technique posed challenges such as increased operative time and a steep learning curve. CONCLUSION: ARIF had favorable radiological and functional outcomes in the patient who was selected after careful evaluation. Copyright: © Indian Orthopaedic Research Group. DOI: 10.13107/jocr.2024.v14.i12.5096 PMCID: PMC11632512