Functional outcome of Closed Schatzker Type V and VI Tibial Plateau Fractures managed by Open Reduction and Internal Fixation: A Prospective study

Kannan, K R (2009) Functional outcome of Closed Schatzker Type V and VI Tibial Plateau Fractures managed by Open Reduction and Internal Fixation: A Prospective study. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Knee joint is an important joint as it is involved in varied functions like load bearing, walking, running, sitting etc. Knee joint is comprised of distal femur, proximal tibia & patella. Injuries of the knee must be treated properly to maintain a good knee function. Fractures of the tibial plateau represent 1% of all fractures and approximately 8% of fractures occurring in the elderly. These are serious injuries resulting frequently in functional impairment. The goals in treating fractures of the tibial plateau are: 1. to restore the joint space, 2. to restore the correct mechanical alignment of the limb, 3. to achieve optimal healing of bone, tendon and ligaments and 4. to allow painless full range of motion of the knee. The optimal treatment of tibial plateau fractures has been a source of controversy for a long time. They were managed both by non-operative and operative methods. Numerous investigators report satisfactory results using either closed or open treatment methods, especially for the less severe type injuries that occur as a result of low energy. For the more severe form of injury which results in comminuted tibial plateau fractures (type V and VI) the ideal mode of treatment is always debatable. Conservative mode of management, Open reduction and internal fixation, closed reduction and percutaneous fixation, Hybrid external fixation have all been suggested. AIM OF THE STUDY: The aim of the study is to analyze prospectively the outcome of closed Schatzker’s type V and VI tibial plateau fractures managed by open reduction and internal fixation, by clinical and radiological methods at Government Royapettah Hospital/Kilpauk Medical College, Chennai, between June 2006 to November 2008. MATERIALS AND METHODS: This is a prospective study conducted in Government Royapettah Hospital/Kilpauk Medical College, Chennai, from June 2006 to November 2008. Twenty patients who satisfied the following criteria were included in the study. Inclusion Criteria: Tibial plateau fractures in adults, Closed fractures, Schatzker’s type V and VI i.e. bicondylar fractures and bicondylar fractures with diaphyseo-metaphyseal dissociation. Exclusion criteria: Tibial plateau fractures; In children, Type I to Type IV, Open fractures, Late cases with joint stiffness, Late cases with infection, Cases of more than 30 days duration, Cases with extensive soft tissue injury whose healing period was more than 21 days. RESULTS: All the 20 patients were available for follow-up and they were followed up every month during the first 4 months and every 2 months during the first year. The minimum follow-up was 8 months and maximum was 24 months, mean follow-up being 15.5 months. The results were analyzed both clinically and radiologically using two scoring systems. 1. Knee Society scoring system by Hospital for Special Surgery which is mainly a clinical scoring system and 2. Rasmussen’s Radiological assessment criteria. CONCLUSION: From our study, we conclude that Open reduction and internal fixation of closed type V and VI tibial plateau fractures is an effective method of treatment even with moderate soft tissue injury when adequate healing period is given. ORIF can restore the maximal joint stability and congruity, which are essential for articular cartilage regeneration. Early mobilization is absolutely essential for preventing the knee stiffness & for quick articular cartilage regeneration. Weight bearing should be delayed until solid union to prevent the articular collapse. Prognosis of this complex fracture depends on 1. The degree of articular depression, 2. The extent and separation of the condylar fracture lines, 3. The degree of diaphyseal-metaphyseal comminution & 4. The integrity of the soft tissue envelope. We found only mild difference in the average scores both clinically and radiologically in assessing the type V and VI fracture patterns. The average knee society score for type V was 80.33 and for type VI it was 80.58. The average RRS for type V was 15 and type VI 15.16.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional outcome of Closed Schatzker ; Type V and VI Tibial Plateau Fractures ; management ; Open Reduction and Internal Fixation ; Prospective study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 18:06
Last Modified: 17 Sep 2017 16:21
URI: http://repository-tnmgrmu.ac.in/id/eprint/2975

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