A viable option for immediate mobilisation: Primary total knee replacement with supplementary osteosynthesis for acute complex tibial plateau fracture in elderly

Muhamad Zharif Asikin, Muhammad Fathi Hayyun, M. F. Yusof
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Abstract

The principle of periarticular fracture is well established. However, the gold standard in treating tibial plateau fracture remains controversial. Lack of adequate soft tissue and complexity of the fracture involved succumbs to poor postoperative outcomes and high complication rate for infection, implant failure and non-union. Furthermore, the treatment of the elderly complicates the decision. It is because time is an essence since decubitus complication is associated with prolonged immobilisation. In addition, other complication related to this fracture such as accelerated secondary osteoarthritis and pain leads to further immobilisation. Traditionally, secondary total knee replacement (TKR) is indicated for this type of fracture, while the initial aim is to achieve bone healing. However, its failure related complication, the detrimental challenge in addressing ligament balance, extensor mechanism scarring and patella mal-tracking, thus, it is not commonly practised. The author has successfully demonstrated the use of primary TKR with supplementary locking plate in a post-traumatic Schatzker V tibial plateau fracture in a 75-year-old gentleman to allow immediate weightbearing. Thus, removing the complication associated with immobilisation and exhibit the advantage of TKR in obtaining a painless functional knee. In successive follow-up shows a favourable outcome and improved functional knee outcome compared to the premorbid state.
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一个可行的选择立即活动:初级全膝关节置换术补充骨合成急性复杂胫骨平台骨折的老年人
关节周围骨折的原理已经确立。然而,治疗胫骨平台骨折的金标准仍然存在争议。由于缺乏足够的软组织和骨折的复杂性,导致术后结果不佳,感染、植入物失败和不愈合的并发症发生率高。此外,老年人的治疗使决定复杂化。这是因为时间是一个本质,因为卧位并发症与长时间的固定有关。此外,与该骨折相关的其他并发症,如继发性骨关节炎加速和疼痛导致进一步的固定。传统上,二级全膝关节置换术(TKR)适用于这种类型的骨折,而最初的目的是实现骨愈合。然而,其失败相关的并发症,解决韧带平衡的不利挑战,伸肌机制瘢痕和髌骨错误跟踪,因此,它不常被应用。作者成功地展示了在一名75岁的男性创伤后Schatzker V型胫骨平台骨折中使用初级TKR加补充锁定钢板,使其能够立即负重。因此,消除与固定相关的并发症,并展示TKR在获得无痛功能膝关节方面的优势。在连续的随访中,与病前状态相比,结果良好,膝关节功能改善。
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CiteScore
0.60
自引率
0.00%
发文量
36
审稿时长
8 weeks
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