Lateral Locked Plating or Dual Plating: A Comparison of Two Methods in Simple Bicondylar Tibial Plateau Fractures.

BACKGROUND: In this study, our aim was to compare the results of the dual locking plate fixation technique and lateral locking plate fixation technique for tibial bicondylar plateau fractures without posteromedial fragment. METHODS: We evaluated 20 patients who underwent surgical treatment due to bicondylar tibial plateau fracture between 2010 and 2015. Ten patients were included in group 1, in which a dual locking plate was employed, whereas 10 patients were included in group 2, in which a lateral locking plate was used. In both groups, functional and clinical outcomes after treatment were rated according to the Knee Society Knee Scoring System, Rasmussen functional score, and Rasmussen radiological score. RESULTS: The mean follow-up time was 24 months. There were no significant differences between the groups with respect to functional and radiographic outcomes at the final follow-up. CONCLUSIONS: In bicondylar tibial plateau fractures without posteromedial fragment, the lateral locking plate fixation technique showed the similar clinical and radiological outcomes as the dual locking plate fixation technique.

Subchondral raft construction with locking plates for the treatment of Schatzker type II fractures.

OBJECTIVES: To evaluate the functional and radiological results of Schatzker type II fractures treated via subchondral raft screws combined with locking plates. METHODS: Twenty-four individuals were enrolled in this study between 2010 and 2014. The depressed joint line was elevated and the defect was filled with allograft. Next, two or three subchondral screws were placed in combination with a locking plate. At the last follow-up, clinical and radiological data were recorded. RESULTS: The mean follow-up period was 21.4 months (12-39). The mean Knee Society Score (KSS) and Rasmussen clinical scores were 91.5 (range, 77-100) and 16.75 (range, 14-18), respectively. The mean Rasmussen radiological score was 27.9 (range, 24-30) during the follow-up. There was no statistically significant difference between injured and non-injured sides with respect to the mechanical axis, the proximal medial tibial angle, and tibial slope. In addition, arthritis showed no difference on the non-injured side, although follow-up was short. CONCLUSIONS: The periarticular raft construction combined with the locking plate helps surgeon to maintain the anatomic line of the joint and the mechanical axis obtained during the surgery. Secondary arthritis seems to be major complication after fractures of the tibial plateau, although the functional results were satisfactory. Level of Evidence IV, Case Series.

OBJETIVOS: Avaliar os resultados funcionais e radiológicos das fraturas de Schatzker tipo II tratadas com parafusos de plataforma subcondral em combinação com placas de trava. MÉTODOS: Vinte e quatro indivíduos foram selecionados para este estudo entre 2010 e 2014. A linha articular deprimida foi elevada e o defeito foi preenchido com aloenxerto. A seguir, dois ou três parafusos subcondrais foram colocados em combinação com uma placa de trava. No último acompanhamento, foram registrados os dados clínicos e radiológicos. RESULTADOS: O período médio de acompanhamento foi 21,4 meses (12-39). A média do Knee Society Score (KSS) e dos escores clínicos de Rasmussen foram 91,5 (faixa, 77-100) e 16,75 (faixa, 14-18), respectivamente. A média do escore radiológico de Rasmussen foi 27,9 (faixa, 24-30) durante o acompanhamento. Não houve diferença estatisticamente significante entre o lado com lesão e sem lesão, com relação ao eixo mecânico, ao ângulo medial proximal da tíbia e à inclinação tibial. Além disso, a artrite não apresentou diferença no lado sem lesão, embora o acompanhamento tenha sido curto. CONCLUSÕES: A construção de plataforma periarticular combinada com placa de trava ajuda o cirurgião a manter a linha anatômica da articulação e o eixo mecânico obtido durante a cirurgia. A artrite secundária parece ser uma complicação importante depois de fraturas do platô tibial, embora os resultados funcionais sejam satisfatórios. Nível de Evidência IV, Série de Casos.

Subchondral raft construction with locking plates for the treatment of Schatzker type II fractures / Construção de plataforma subcondral com placas de trava para o tratamento de fraturas do tipo II de Schatzker

ABSTRACT OBJECTIVES: To evaluate the functional and radiological results of Schatzker type II fractures treated via subchondral raft screws combined with locking plates. METHODS: Twenty-four individuals were enrolled in this study between 2010 and 2014. The depressed joint line was elevated and the defect was filled with allograft. Next, two or three subchondral screws were placed in combination with a locking plate. At the last follow-up, clinical and radiological data were recorded. RESULTS: The mean follow-up period was 21.4 months (12-39). The mean Knee Society Score (KSS) and Rasmussen clinical scores were 91.5 (range, 77-100) and 16.75 (range, 14-18), respectively. The mean Rasmussen radiological score was 27.9 (range, 24-30) during the follow-up. There was no statistically significant difference between injured and non-injured sides with respect to the mechanical axis, the proximal medial tibial angle, and tibial slope. In addition, arthritis showed no difference on the non-injured side, although follow-up was short. CONCLUSIONS: The periarticular raft construction combined with the locking plate helps surgeon to maintain the anatomic line of the joint and the mechanical axis obtained during the surgery. Secondary arthritis seems to be major complication after fractures of the tibial plateau, although the functional results were satisfactory. Level of Evidence IV, Case Series.

RESUMO OBJETIVOS: Avaliar os resultados funcionais e radiológicos das fraturas de Schatzker tipo II tratadas com parafusos de plataforma subcondral em combinação com placas de trava. MÉTODOS: Vinte e quatro indivíduos foram selecionados para este estudo entre 2010 e 2014. A linha articular deprimida foi elevada e o defeito foi preenchido com aloenxerto. A seguir, dois ou três parafusos subcondrais foram colocados em combinação com uma placa de trava. No último acompanhamento, foram registrados os dados clínicos e radiológicos. RESULTADOS: O período médio de acompanhamento foi 21,4 meses (12-39). A média do Knee Society Score (KSS) e dos escores clínicos de Rasmussen foram 91,5 (faixa, 77-100) e 16,75 (faixa, 14-18), respectivamente. A média do escore radiológico de Rasmussen foi 27,9 (faixa, 24-30) durante o acompanhamento. Não houve diferença estatisticamente significante entre o lado com lesão e sem lesão, com relação ao eixo mecânico, ao ângulo medial proximal da tíbia e à inclinação tibial. Além disso, a artrite não apresentou diferença no lado sem lesão, embora o acompanhamento tenha sido curto. CONCLUSÕES: A construção de plataforma periarticular combinada com placa de trava ajuda o cirurgião a manter a linha anatômica da articulação e o eixo mecânico obtido durante a cirurgia. A artrite secundária parece ser uma complicação importante depois de fraturas do platô tibial, embora os resultados funcionais sejam satisfatórios. Nível de Evidência IV, Série de Casos.

[Comparison of 90° and 180° plate constructions for comminuted distal humerus fractures in adults, and effects on clinical results]. / Eriskin humerus alt uç eklem içi parçali kiriklarda 90° ve 180° plak uygulamalarinin karsilastirilmasi ve klinik sonuçlar üzerine etkisi.

BACKGROUND: The present objective was to compare 90° and 180° double-plate constructions for complex distal humerus fractures, as well as to evaluate superiority of construction type. METHODS: Retrospectively evaluated were 17 patients treated for type C distal humerus fracture according to AO/ASIF classification between January 2009 and January 2013. All attended minimum 6-month follow-up. Elbow function was assessed with anteroposterior and lateral x-ray, and Mayo elbow performance score evaluation at outpatient clinics. RESULTS: Patient population included 14 males (82.3%) and 3 females (17.7%). Mean patient age was 40.5 years. According to AO/ASIF distal humerus classification, 3 (17.7%) type C1, 9 (52.9%) type C2, and 5 (29.4%) type C3 fractures were included. Six were open fractures (35.3%). According to Gustilo-Anderson classification, 4 (23.5%) fractures were type 1, and 2 (11.7%) were type 2. Construction performed was 90° in 11 cases (64.7%) and 180° in 6 cases (36.3%). Chevron osteotomy was performed in all cases. Mean follow-up period was 25.6 (6-52) months. Upon final examination, mean elbow flexion was 105º (85º-130º), and mean extension loss was 10º (0º-20º). According to Mayo elbow performance scoring system, 12 (70.5%) results were excellent, and 5 (29.5%) were good. No statistically significant clinical difference was found between 90° and 180° plate construction groups (p=0.169). DISCUSSION: Surgeons should determine the construction type appropriate to individual cases of adult distal humerus type C fractures using preoperative x-rays and intraoperative means. Choice of construction type has particular importance in cases of lateral columnar fracture complexity. If no comminution is present in the lateral column, 90º double-plating leads to satisfactory outcome, while 180º plating leads to satisfactory outcome when comminution is present in the lateral column.

The effect of early weight-bearing on comminuted calcaneal fractures treated with locking plates.

OBJECTIVES: This study aims to evaluate the possible effects of early weight-bearing on clinical and radiological outcomes of comminuted calcaneal fractures treated with locking plates. PATIENTS AND METHODS: This retrospective study included 15 patients (12 males, 3 females; mean age 40.1 years; range 18 to 55 years) with comminuted calcaneal fractures between October 2010 and April 2012. Standard lateral extensile approach was carried out for surgical exposure. A corticocancellous allograft was used to fill the defect following the reduction and fixation of posterior facet. Titanium locking plates and screws were used to maintain reduction. The patients were encouraged for a limited weight-bearing at six weeks postoperatively, if tolerated. All patients were able to full weight-bear at 12 weeks postoperatively. Clinical and radiological assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) and Maryland scores. RESULTS: The mean follow-up was 19 months (range, 12 to 27 months). The AOFAS and Maryland scores were 89 and 88.46 points, respectively. The Böhler's angle showed 0.3° loss from early post-surgery to the last visit. Among the workers, all returned to work but one with Sanders type IV fracture and all retired patients returned to their daily activities. The functional status of the patient with Sanders type IV fracture was poor according to the AOFAS and Maryland criteria. CONCLUSION: Based on radiographic and clinical assessment, there was no unfavorable effect of early weight-bearing after calcaneal fracture surgery. Therefore, these results suggest that sufficient stability can be achieved by locking plates in comminuted calcaneal fractures, when early weight-bearing is recommended, even.