A prospective study of operative results of intra-articular fractures of proximal tibia
Journal Title: National Journal of Clinical Orthopaedics - Year 2017, Vol 1, Issue 1
Abstract
Introduction: Proximal tibial fracture is a common injury, with some of these fractures being caused by a strong impact such as a traffic accident and others being caused by the relatively weak impact of a fall in elderly people. Such fractures are frequently intraarticular and comminuted and it is likely that secondary osteoarthritis will occur due to residual malalignment of the lower extremity or irregularity of the articular surface, especially in patients with comminuted intraarticular fractures. To preserve normal knee function, surgeon must strive to maintain joint congruity, preserve normal mechanical axis, ensure joint stability and restore a full range of motion. Methods: We have studied 50 cases of fractures of upper end tibia with intraarticular extension, treated at our tertiary care institute with different modalities of fixation during the period of Jan 2017 to May 2017. We used Schatzker type I – VI classification. Surgical techniques used were external fixation, open reduction and internal fixation, ligament injury repair with condylar fracture and arthroscopically assisted reduction and fixation of tibial plateau. Results: We used knee society scores (max. 350) used for final follow up at 1 year. Functional was Excellent in 82% (41), good in 6% (3), Fair in 12% (6) patients. In type I fracture 3 patients had excellent result, 1 patient had fair result. In type II/III/IV fracture all patients having excellent result. In type V fracture patients treated with double plate (2) had excellent result and single plate (15), 12 had excellent, 2 patients had good and 1 had fair result. 1 patient with preexisting osteoarthritis treated with hybrid fixator complicated by infection had fair result. 1 patient treated with C.C. (Cannulated Cancellous) screw had fair result. In type VI fracture, 6 patients treated with plate had excellent result. Out of 4 patients treated with hybrid fixator 3 had excellent result and 1 had good result. One patient had excellent and one had fair result treated with external fixator. Conclusion: Open reduction and internal fixation (ORIF) is the gold standard treatment for these fractures. Complex articular fractures can be treated by ring external fixators and minimally-invasive osteosynthesis (EFMO) or by ORIF. EFMO can be related to suboptimal articular reduction; however, outcome analysis shows results that are equal to, or even superior to, ORIF. The ORIF strategy should also include the optimal reduction of the articular surface.
Authors and Affiliations
Dr. Mohit Jain, Dr. Bhavna Singla, Dr. Kinjal Mavani
Keywords
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