CERRAHİ OLARAK TEDAVİ EDİLEN TİBİA PLATO KIRIKLARINDA RASMUSSEN RADYOLOJİK VE KLİNİK SKORLARI OSTEOARTRİT EVRESİNİ ETKİLER Mİ?

Abstract

Amaç: Bu çalışmanın amacı tibia plato kırıklarının sonuçlarını etkileyen faktörleri araştırmak ve Rasmussen radyolojik ile klinik skorlar ve bu skorların osteoartirit evresi arasındaki ilişkinin değerlendirilmesidir.             Gereç ve Yöntem: Ankara Numune Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji A Kliniğinde 2007 Ocak–2013 Haziran tarihleri arasında tibia plato kırığı tanısı ile cerrahi tedavisi yapılan 30 hasta  çalışmaya alındı. Hastaların sonuçları retrospektif olarak değerlendirildi.

Bulgular: 21’i (%70) erkek, 9’u (% 30) kadındı. Hastaların yaş aralığı 18-71 arasında değişmekte olup ortalama yaş 45,7±15.2 olarak bulundu. Çalışmaya alınan 30 hastanın toplamda 30 plato kırığının 16 (%53.3) kırık solda, 14 (% 46.6) kırık sağ taraftaydı. Hastalar ortalama 3 (1-14) gün içerisinde ameliyat edildi. Ortalama takip süresi 23.3±17.8 (6-72) ay olarak bulundu.

Yaralanma mekanizması 10 hastada araç içi trafik kazası, 3 hastada araç dışı trafik kazası, 7 hastada yüksekten düşme, 6 hastada basit düşme, 1 hastada spor yaralanması, 1 hastada ateşli silah yaralanması, 2 hastada ise darp idi.

Kırıkların dağılımı açısından incelendiğinde Schatzker sınıflamasına göre 6 kırık tip 1, 11 kırık tip 2, 1 kırık tip 3, 3 kırık tip 4, 8 kırık tip 5, 1 kırık tip 6  idi. Tespit materyali olarak 24 hastada Liss plağı, 6 hastada kanüllü vida, 1 hastada da hem liss plağı ve kanüllü vida kullanıldı. Rasmussen klinik değerlendirilmesine göre 19 hastada mükemmel, 8 hastada iyi, 3 hastada orta sonuçlar elde edilmiştir. Rasmussen radyolojik değerlendirilmesinde ise 2 hastada mükemmel, 17 hastada iyi, 8 hastada orta, 3 hastada kötü sonuçlar elde edilmiştir.

Olgular komplikasyon açısından değerlendirildiğinde 8 olguda eklem hareket kısıtlılığı, 1 olguda derin ven trombozu. 2 olguda biri tamamiyle iyileşmiş safen sinirin infrapatellar sinir yaralanması, 4 olguda antibiyotik tedavisine yanıt veren yüzeyel yumuşak doku enfeksiyonu saptandı.

Sonuç: Sonuç olarak tibia plato kırıkları eklemi ilgilendiren kırıklar olduğundan, kırığın tipi ve yeri, yer degistirme ve parçalanmanın derecesi ve eslik eden kemik ve yumusak doku hasarları dikkate alınarak uygun cerrahi yöntem seçilmelidir. Rasmussen radyolojik ve klinik skorlar ile osteoartrit evresi arasında bir ilişki saptanamamıştır. Rasmussen klinik skorlar ile radyolojik skorlar arasında orta dereceden ilişki mevcuttur.

Keywords

• Rasmussen kriterleri,Schatzker sınıflandırması

DOES RASMUSSEN RADIOLOGICAL AND CLINICAL SCORES OF PATIENTS WHOM WERE TREATED SURGICALLY FOR TIBIAL PLATEAU FRACTURES EFFECT OSTEOARTHRITIS GRADE?

Abstract

    

          Objective: The aim of this study is to research the factors affecting the result of tibia plateau fractures and evaluating the correlation between the clinic scores and Rasmussen radiologic and osteoarthritis stage.

Material and Methods: Between January 2007 and June 2013, in the Department of Orthopaedics and Traumatology of Ankara Numune Education and Research Hospital Clinic A 30 patients who were made surgical treatment diagnosed with tibia plateau fractures evaluated.  Results of patients were evaluted retrospectively.

Results: 21(%70) of patients were male and remaining 9 (%30) were female. The ages of the patients were between 18-71 and average patient age was 45.7± 15.2. 16 fractures were located on the left side and 14 were on the right side. The surgical treatment of these case patients complited between 1-14 days. The average follow-up was 23.3±17.8(6-72) months.

The most common mechanism of injury was motor wehicle accident.

The fractures were classified according to Schtazker. There were 6 type I, 11 type II, 1 type III, 3 Type IV, 8 type V and 1 type VI. We used Liss plate in 23 patients, cannulated screw in 6 patients and both liss plate and canulated screw in one patient. According to Rasmussen clinical score, 19 cases had an excellent result, 8 cases had a good result, 1 case had a modarete result. According to Rasmussen radiological score, 2 cases had an excellent result, 17 cases had a good result, 8 case had a modarete result 3 cases bad result.

Postoperative complications included superficial infections in four patients, arthrofibrosis in eight patients, deep vein thrombosis in one patient and infrapatellar nerve injury in one patients.

Conclusion: Consequently, as tibial plateau fractures are articular fractures, proper surgical method should be selected by taking into consideration the type and area of fracture, degree of migration and fracture, and the accompanying damages of bone and soft tissue.

Keywords

• Rasmussen score,Schatzker’s classification,Tibial plateau fracture

References

1. 1. Ali AM. Outcomes of open bicondylar tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation Eur. J. Orthop. Surg. Traumatol. P349-55 1997.
2. 2. İşyar M, Tonbul M, Tırmık Ü, Çakmak S, Mahirogulları M, Erler K. Surgical treatment results of tibial plateau fractures. Okmeydani Tip Derg. 2015;31(4):199-206.
3. 3. Watson J, Wiss D. Fractures of the proximal tibia and fibula. In: Rockwood C, Green D, Bucholz R, eds. Fractures in adults, 5th ed. Philadelphia, Lippincott Williams-Wilkins Company p1801-1841. 2001.
4. 4. Honkonen SE. Indications for surgical treatment of tibial condyle fractures. Clin Orthop Relat Res. 1994;302:199-205.
5. 5. Hohl M. Complication Of Tibial Plateau Fractures;Complication İn Othopaedic Surgery 3th Edition Chapter 20.3 540-552 1995.
6. 6. Resnic D, Niwoyama G. Diagnosis of Bone Joint Disorders Philadelphia; W.B Saunders 1981.
7. 7. Waddell JP, Johnston DW, Neidre A. Fractures of the tibial plateau: a review of ninety-five patients and comparison of treatment methods. J Trauma. 1981;21(5):376-81.
8. 8. Bowes DN, Hohl M. Tibial condylar fractures. Evaluation of treatment and outcome. Clin Orthop Relat Res. 1982;171:104-8.

9. 9. Lansinger O, Bergman B, Komer L. Tibial Condylar Fractures: A Twenty- Year Follow up, J Bone Joint Surg. p13-19, 1986.
10. 10. Etel K, Zafer O, Parmaksızoğlu. A, Ahmet E, Nuzhet Y. Tibia plato kırıklarının cerrahi tedavisinde sonuçları etkileyen faktörler Acta Orthop Traumatol Turc 2000;34:34-39.
11. 11. Hohl M. Fractures of the proximal tibia and fibula. In: Rockwood CA, Green PD, Bucholz W, editors. Fractures in adults. Philadelphia: J.B. Lippincott Comp. 1725-61 1991.
12. 12. Hohl M. Tibial condylar fractures J. Bone Joint Surg. Am. 49-7 p1455-67 1967.
13. 13. Rıdvan E. Tibia proksimal bölge kırık ve çıkıkları. Travmatoloji. 5. baskı, Ankara: Bizim Büro Yayıncılık Tic. Ltd. Sti. s3843-3896 2003.
14. 14. Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res. 1993;292:87-100.
15. 15. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am. 1973;55(7):1331-50.16. Schatzker J MR, Bruce D. Tibial plateau fractures: the toronto experience 1968–1975. Clin, Orthop Relat Res.
16. 17. Blokker CP, Rorabeck CH, Bourne RB. Tibial plateau fractures. An analysis of the results of treatment in 60 patients Clin. Orthop. Relat. Res. 193-9 1984.182.
17. 18. Shatzker J, Mcbroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975 1979.
18. 19. Jensen DB, Rude C, Duus B, Bjerg-Nielsen A. Tibial plateau fractures. A comparison of conservative and surgical treatment. J Bone Joint Surg Br. 1990;72(1):49-52.
19. 20. Gossling HR, Peterson CA. A new surgical approach in the treatment of depressed lateral condylar fractures of the tibia. Clin Orthop Relat Res. 1979;140:96-102.
20. 21. Harper MC, Henstorf JE, Vessely MB. Closed reduction and percutaneous stabilization of tibial plateau fractures. Orthopaedics,18 :623 -626 1995.
21. 22. Hohl M, Moore T.M.:. Articuler fractures of the proximal tibia surgery of the musculoskeletal sistem. Edit by C. Mc Collister Evarts 1983; New York 3(7): 111-134,. 1983.23. Sirkin MS, Bono CM, Reilly MC, Behrens FF. Percutaneous methods of tibial plateau fixation. Clin Orthop Relat Res. 2000;375:60-8.
22. 24. Burri C, Bartzke G, Coldewey J, Muggler E. Fractures of the tibial plateau. Clin Orthop Relat Res. 1979;138:84-93.
23. 25. Hohl M. Treatment methods in tibial condylar fractures. South Med J. 1975;68(8):985-91.
24. 26. Lachiewicz PF, Funcik T. Factors influencing the results of open reduction and internal fixation of tibial plateau fractures. Clin Orthop Relat Res. 1990;259:210-5.
25. 27. Segal D, Mallik AR, Wetzler MJ, Franchi AV, Whitelaw GP. Early weight bearing of lateral tibial plateau fractures. Clin Orthop Relat Res. 1993;294:232-7.
26. 28. Bennett WF, Browner B. Tibial plateau fractures: a study of associated soft tissue injuries. J Orthop Trauma. 1994;8(3):183-8.
27. 29. Ergan G, Türkmen GM, Bombacı H, Kafadar A. Aşırı çökmüş (5 mm üzerinde) Lateral Tibia Plato Kırıklannda Tedavi Protokolü XIII. Milli Türk Ortopedi ve Travmatoloji Kongresi Kitabı s69-693 1994.
28. 30. Watson JT, Schatzker J. Tibial plateau fractures. In: Browner BD, Levine AM, Jupiter JB, Trafton PG, editors. Skeletal trauma. Vol 2. 2 nd ed. Philadelphia: WB Saunders Co; p2143-2186 1998.
29. 31. Moore TM. Fracture--dislocation of the knee. Clin Orthop Relat Res. 1981;156:128-40.
30. 32. Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994;23(2):149-54.
31. 33. Lobenhoffer P, Schulze M, Gerich T, Lattermann C, Tscherne H. Closed reduction/percutaneous fixation of tibial plateau fractures: arthroscopic versus fluoroscopic control of reduction. J Orthop Trauma. 1999;13(6):426-31.
32. 34. Spiegel Lv. Tibial Plateau Fracfures. Clinical Orthopaedics and Releated Research 1979.:138:12-16.
33. 35. Delamarter RB, Hohl M, Hopp E, Jr. Ligament injuries associated with tibial plateau fractures. Clin Orthop Relat Res. 1990;250:226-33.
34. 36. Drennan DB, Locher FG, Maylahn DJ. Fractures of the tibial plateau. Treatment by closed reduction and spica cast. J Bone Joint Surg Am. 1979;61(7):989-95.
35. 37. Struben PJ. The tibial plateau. J Bone Joint Surg Br. 1982;64(3):336-9.
36. 38. Apley AG. Fractures of the tibial plateau Orthop Clin North Am 10-1 p61-74 1979.
37. 39. DeCoster TA, Nepola JV, el-Khoury GY. Cast brace treatment of proximal tibia fractures. A ten-year follow-up study. Clin Orthop Relat Res. 1988;231:196-204.
38. 40. Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am. 2002:1541-51.
39. 41. Volpin G, Dowd GS, Stein H, Bentley G. Degenerative arthritis after intra-articular fractures of the knee. Long-term results. J Bone Joint Surg Br. 1990;72(4):634-8.
40. 42. Honkonen SE. Degenerative arthritis after tibial plateau fractures. J Orthop Trauma. 1995;9(4):273-7.
41. 43. Aglietti Buzzi R. fractures of the Tibia Plateau in "Surgery of the knee" Insali.J.N., Windsor, R.E.W.N Churchili Livingstone, New York, U.S.A., 2nd Edition Chapter 36 1035-1081, 1993.