A novel minimally invasive technique for the treatment of tibial plateau collapse fracture: radiological and arthroscopic evaluation.

Abstract

Purpose: To examine the effectiveness of a novel bone graft reduction technique with a bone tamp impactor instrument in minimally invasive treatment of tibial plateau collapse fractures through arthroscopic and imaging evaluation.

Methods: This is a retrospective analysis of prospectively collected data on patients with tibial plateau collapse fracture who received the novel bone graft reduction procedure with a bone tamp impactor instrument for minimally invasive treatment of tibial plateau collapse fractures in a tertiary referral university hospital from February 2021 to March 2023. Patients were classified according to a classification combined with Schatzker classification, AO classification and three-column classification. Arthroscopy evaluation and radiographs were used to measure the reduction effect.

Results: A total of 196 patients were eligible and included. Compared to the preoperative values, post-ADD(c) showed a significant reduction improvement (P = 0.000-0.007), ranging from 87.9 to 96.6% for different classifications. The post-ADD (s) have decreased by 87-96.8% (P = 0.000-0.039), the post-FFG and post-TPW reduced by 87.5-100% (P = 0.000-0.026) and 34.2-63.5% (P = 0.000-0.075) respectively. Additionally, the lower limb alignment have been significantly corrected, with notable changes in post-MPTA (P = 0.000-0.081), post-PTSA (P = 0.000-0.178) and post-FTA (P = 0.000-0.069) for different types of fracture, measured one day after surgery. Arthroscopic evaluation indicated that the average articular surface depression depth was less than 4 mm, and over 60% achieved a depression depth of less than 2 mm. All patient achieved a less than 2 mm of postoperative fracture fragment gap, with over 50% achieving a gap of less than 1 mm. None of patients experienced neurovascular injury or wound infection.

Conclusion: The novel bone graft reduction technique utilizing a bone tamp impactor instrument can achieve effective reduction in all types of tibial plateau collapse fractures. This method may prove to be a useful option for minimally invasive treatment of tibial plateau fractures.