Outcomes of arthroscopic-assisted fixation of intra-articular proximal tibial fractures by circular external fixator

A. Toreih, Mohammed I Rakha
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Abstract

Background Fractures of the tibial plateau usually result from high-energy trauma. Motor vehicle accidents seem to be the predominant cause worldwide. The objective of treating displaced fractures is to restore the articular surface anatomy and repair soft tissue injuries. We aim to improve the functional and radiological results of the arthroscopically assisted fixation of the tibial plateau fractures using Ilizarov fixator. Methods The study was carried out on patients attending to Orthopedic Surgery Department at a major metropolitan hospital in Egypt, between March 2019 to September 2020. Forty-five patients with tibial plateau fractures of Schatzker classification type II to type VI were operated on. Results The results indicate that the Ilizarov method is a valuable alternative in treating Schatzker II-VI fracture types. The mean time from injury to partial weight bearing (PWB) and full weight bearing (FWB) were 12.75 and 22.73 weeks, respectively. The mean Knee Society Score was 75.42 ± 9.91. Over 70% of self-reported Overall Functional Grades were deemed ‘good’ (n=21, 47.6%) or ‘excellent’ (n=12, 26.7%) at the end of the follow-up period. Pin tract infection was reported in 31(68.9%) cases, and delayed union developed in 7 (15.6%) cases. Conclusion Early and definite fixation is achieved with the Ilizarov and arthroscopic technique, allowing intra-articular assessment of the reduction, and management of associated intra-articular soft tissue injuries with immediate PWB. It is believed that this minimally invasive method does not lead to the additional morbidity and the combined advantages of arthroscopy and Ilizarov allows successful fixation and early activity.
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关节镜辅助下用圆形外固定架固定胫骨近端关节内骨折的疗效
背景:胫骨平台骨折通常是由高能创伤引起的。机动车事故似乎是世界范围内的主要原因。治疗移位性骨折的目的是恢复关节面解剖结构和修复软组织损伤。我们的目的是提高关节镜下使用Ilizarov固定架固定胫骨平台骨折的功能和放射学效果。方法研究对象为2019年3月至2020年9月在埃及某大城市医院骨科就诊的患者。对45例Schatzker分型胫骨平台骨折进行手术治疗。结果Ilizarov方法是治疗Schatzker II-VI型骨折的一种有价值的方法。从损伤到部分负重(PWB)和完全负重(FWB)的平均时间分别为12.75和22.73周。膝关节社会评分平均值为75.42±9.91。在随访结束时,超过70%的自我报告的整体功能等级被认为是“良好”(n=21, 47.6%)或“优秀”(n=12, 26.7%)。针道感染31例(68.9%),延迟愈合7例(15.6%)。结论:采用Ilizarov和关节镜技术可以实现早期和明确的固定,允许关节内评估复位,并处理即刻PWB相关的关节内软组织损伤。人们认为这种微创方法不会导致额外的发病率,关节镜和Ilizarov的综合优势允许成功的固定和早期活动。
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