ABSTRACT
PURPOSE: Treatment for tibial plateau fractures continues to evolve but maintains primary objectives of anatomic reduction of the joint line and a rapid recovery course. Arthroscopic-assisted percutaneous fixation (AAPF) has been introduced as an alternative to traditional open reduction internal fixation (ORIF). The purpose of the study is to compare clinical and radiographic outcomes in patients with low-energy Schatzker type I-III tibial plateau fractures treated with AAPF versus ORIF. METHODS: A retrospective chart review was performed at a level 1 trauma centre to compare outcomes of 120 patients (57 AAPF, 63 ORIF) with low-energy lateral Schatzker type I-III tibial plateau fractures who underwent tibial plateau fixation between 2009 and 2018. Demographic information, injury characteristics, and surgical treatment were recorded. The main outcome measurements included reduction step-off, joint space narrowing, time to weight bearing, and implant removal. RESULTS: There was no difference in age, gender distribution, BMI, ASA, Schatzker classification distribution, initial displacement, blood loss, and reduction step-off between the two groups (p > 0.05). Shorter tourniquet time (74.1 ± 21.7 vs 100.0 ± 21.0 min; p < 0.001), shorter time to full weight bearing (47.8 ± 15.2 vs. 69.1 ± 17.2 days; p < 0.001), and lower rate of joint space narrowing (3.5% vs. 28.6% with more than 1 mm, p < 0.001) were associated with the AAPF cohort, with no difference in pain, knee range of motion, or implant removal rate between the two cohorts. CONCLUSION: AAPF may be a viable alternative to ORIF for the management of low-energy tibial plateau fractures with outcomes not inferior compared to the traditional ORIF method.
Subject(s)
Tibial Fractures , Tibial Plateau Fractures , Humans , Retrospective Studies , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/methods , Open Fracture Reduction/adverse effects , Open Fracture Reduction/methods , Tibial Fractures/diagnostic imaging , Tibial Fractures/surgery , Treatment OutcomeABSTRACT
ABSTRACT: One World Surgery (OWS) is a medical mission organization that treats a variety of orthopaedic conditions and focuses on local partnerships, education, capacity-building, and high-quality care. OWS runs a Honduran ambulatory surgery center (ASC) with >50 full-time local staff; it operates year-round and accommodates visiting surgical teams bimonthly. Across its 12-year history, 8,703 surgical procedures have been performed and 54,940 total consults have been completed, with increasing autonomy of the local medical staff. From 2009 through 2021, OWS has provided 74 million U.S. dollars in surgical and consult patient care. By addressing global surgical disparities via life-enhancing surgical care in low- and middle-income country (LMIC) settings, the OWS ASC mission model may be a useful blueprint for other medical missions.
Subject(s)
Medical Missions , Musculoskeletal Diseases , Humans , Honduras , Referral and Consultation , Capacity BuildingABSTRACT
CASE: We report a 67-year-old healthy man who sustained bilateral hyper-plantarflexion injuries falling off a ladder that resulted in bilateral tibialis anterior tendon tears one month prior to presentation. His injuries were effectively managed with bilateral delayed operative treatment. After non-weightbearing for three months, the patient was subsequently permitted to full weight bear in CAM boots for three months. At three-year follow-up he was fully functional with excellent Foot and Ankle Ability Measure (FAAM scores). CONCLUSION: The management delayed tibialis anterior tendon ruptures, whether due to traumatic or degenerative mechanisms is challenging and surgical repair can be effective when this injury occurs bilaterally.