Comparison of anterior midline incision and double incision in the surgical treatment of tibial plateau fractures

Yıl 2023, , 347 - 352, 27.03.2023

Ömer Bozduman

https://doi.org/10.32322/jhsm.1218765

Öz

Aim: Tibial plateau fractures are complex fractures that often develop after high-energy trauma, often involving intra-articular fractures. They are rarely treated conservatively. Surgical planning and approach are very important in preventing possible complications. In this study, we compared two different incisions in the same fracture types.
Material and Method: A total of 26 patients (20 males-6 females) with tibial plateau fractures were included in the study. Twelve of the patients were selected from those using anterior midline incisions, and 14 from those using double incisions as anterolateral and posteromedial incisions. The mean age of the patients is 50.8 (24-76) years. The distribution of patients according to fracture classification was 9 Schatzker type-6, 17 Schatzker type-5. Average follow-up time is 34.1 months (24.5-42.2). Postoperative complications, union time, joint range of motion, radiological Rasmussen criteria, Medial Proximal Tibial Angle (MPTA) and Posterior Proximal Tibial Angle (PPTA) measurements, Lachman and valgus-varus stress tests for ligament stability evaluation, Hospital for Special Surgery (HSS) and visual analogue scale (VAS) assessments were performed to evaluate the clinical status of the patients. Results were compared between both incision groups.
Results: Union in the anterior midline was 11.07 (±1.68) weeks and bilateral union was 9.96 (±1.35) weeks (p :0.074). Rasmussen scoring was 14.83 (±2.16) in the anterior group and 14.57 (±2.13) in the bilateral group (p:0.760). The MPTA was 85.35 (±3.97) degrees in the anterior group, and the MPTA was 86.40 (±3.74) degrees in the bilateral group (p: 0.492). PPTA was 80.77 (±1.95) degree in the anterior group, and PPTA was 80.85 (±1.78) degree in the bilateral group. HSS score was 70 (±9.02) in the anterior group and HSS score was 71.71 (±1.15) in the bilateral group (p:0.681). Rom was measured as 101.67 (±12.67) degrees in the anterior group and 107.86 (±13.54) degrees in the bilateral group (p: 0.243). The VAS anterior group was 2.83 (±1.64) and the VAS bilateral group was 3.36 (±2.09) (p:0.491).Instability was seen in 1 patient in the anterior group and 1 patient in the bilateral group (p:1). Infection was observed in 1 patient in the anterior group and in 3 patients in the bilateral group (p:0.598).
Conclusion: The anterior incision is as effective a surgical approach as bilateral incision in correct patient preferences. Surgical site visibility in anterior incision is satisfactory. The principal aspect is to perform the correct surgical planning for the correct patient.

Anahtar Kelimeler

tibial plateau fracture, anterior Midline Incision, visual analogue scale

Kaynakça

• Berkson EM, Virkus WW. High-energy tibial plateau fractures. J Am Acad Orthop Surg 2006; 14: 20-31.
• Tsuchie H, Okada K, Nagasawa H, Chida S, Shimada Y. Bilateral stress fracture of the fibulae and periostitis of the tibiae. Med Princ Pract Int J Kuwait Univ Health Sci Cent 2010; 19: 490-2.
• Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop 1979; 138: 94-104.
• Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 2004; 18: 649-57.
• Perry CR, Evans LG, Rice S, Fogarty J, Burdge RE. A new surgical approach to fractures of the lateral tibial plateau. J Bone Joint Surg Am1984; 66: 1236-40.
• Padanilam TG, Ebraheim NA, Frogameni A. Meniscal detachment to approach lateral tibial plateau fractures. Clin Orthop 1995; 314: 192-8.
• Wang Z, Wang Y, Tian S, et al. Dual plating or dual plating combined with compression bolts for bicondylar tibial plateau fractures: a retrospective comparative study. Sci Rep 2021; 11: 7768.
• Abdel MP, von Roth P, Cross WW, Berry DJ, Trousdale RT, Lewallen DG. Total knee arthroplasty in patients with a prior tibial plateau fracture: a long-term report at 15 years. J Arthroplasty 2015; 30: 2170-2.
• Houdek MT, Watts CD, Shannon SF, Wagner ER, Sems SA, Sierra RJ. Posttraumatic total knee arthroplasty continues to have worse outcome than total knee arthroplasty for osteoarthritis. J Arthroplasty 2016; 31: 118-23.
• Saleh H, Yu S, Vigdorchik J, Schwarzkopf R. Total knee arthroplasty for treatment of post-traumatic arthritis: Systematic review. World J Orthop 2016; 7: 584-91.
• Scott CEH, Davidson E, MacDonald DJ, White TO, Keating JF. Total knee arthroplasty following tibial plateau fracture: a matched cohort study. Bone Jt J 2015; 97: 532-8.
• Chakraverty JK, Weaver MJ, Smith RM, Vrahas MS. Surgical management of tibial tubercle fractures in association with tibial plateau fractures fixed by direct wiring to a locking plate. J Orthop Trauma 2009; 23: 221-5.
• Cakar M, Gurbuz H. Anterior Midline Knee Incision Method is a Viable Solution for Schatzker type V and VI tibial plateau fractures. Eur Arch Med Res 2018; 34: 137-42.
• Kumar V, Singhroha M, Arora K, Sahu A, Beniwal R, Kundu A. A clinico-radiological study of bicondylar tibial plateau fractures managed with dual locking plates. J Clin Orthop Trauma 2021; 21: 101563.
• Citak C, Kayali C, Ozan F, Altay T, Karahan HG, Yamak K. Lateral locked plating or dual plating: a comparison of two methods in simple bicondylar tibial plateau fractures. Clin Orthop Surg 2019; 11: 151-8.
• Raj M, Gill S, Rajput A, Singh KS, Verma KS. Outcome analysis of dual plating in management of unstable bicondylar tibial plateau fracture - a prospective study. Malays Orthop J 2021; 15: 29-35.
• Mandal A, Dutta P, Sarkar PS, Bandyopadhyay U, Santra S. Single long midline incision versus two small incision techniques in treatment of Schatzker type V and type VI tibial plateau fractures--a comparative study. J Indian Med Assoc 2013; 111: 804-5.
• Guild TT, Stenquist DS, Yeung CM, Harris MB, Von Keudell AG, Smith RM. Single versus dual incision approaches for dual plating of bicondylar tibial plateau fractures have comparable rates of deep infection and revision surgery. Injury 2022; 53: 3475-80.
• Cho KY, Oh HS, Yoo JH, Kim DH, Cho YJ, Kim KI. Treatment of Schatzker Type V and VI Tibial Plateau Fractures Using a Midline Longitudinal Incision and Dual Plating. Knee Surg Relat Res 2013; 25: 77-83.