OBJECTIVE: To analyze the anatomic accuracy of fracture reduction controlled by fluoroscopy as compared with arthroscopically assisted reduction ("fracturoscopy") in patients with complex tibial plateau fractures (AO/OTA 41-C). Quality of fracturoscopy-guided reduction was checked with postoperative computed tomography. DESIGN: Prospective observational study. SETTING: Urban level 1 trauma center. PATIENTS: Seventeen consecutive patients, with a complex, bicondylar tibial plateau fracture. INTERVENTION: The intraoperative, open insertion of an arthroscope (2.4-mm or 2.8-mm optics), to visualize the articular surface and fracture reduction. MAIN OUTCOME MEASUREMENTS: Ability to detect residual fracture depression or gap after previous open reduction under fluoroscopic guidance. RESULTS: An open fracture reduction with fluoroscopic guidance was performed in all cases. In 7 cases, open reduction and fluoroscopy resulted in satisfactory fracture reduction (fluoroscopy group). In 10 of 17 cases, subsequent "fracturoscopy" showed persistent fracture depression (≥2 mm, fracturoscopy group) with the need for intraoperative correction. Patients in the fracturoscopy group demonstrated significantly greater preoperative fragment depression (12.55 ± 6.56 mm) and a larger preoperative fracture gap (7.83 ± 5.49 mm) compared with patients with a satisfactory reduction under fluoroscopy (depression 4.97 ± 4.02 mm, P = 0.016; gap 2.47 ± 1.07 mm, P = 0.023). Fluoroscopy was not successful in achieving satisfactory reduction in cases in which the postero-latero-central region was affected (P = 0.004, χ test). Postoperative computed tomography demonstrated satisfactory articular reconstruction in all cases. CONCLUSIONS: Intraoperative fracturoscopy permitted a significantly improved visualization of fracture fragment displacement, specifically in the postero-latero-central region of the tibial plateau, as compared with fluoroscopy. Fracturoscopy is recommended for fractures involving the postero-latero-central region of the tibial plateau. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVE: To analyze the anatomic accuracy of fracture reduction controlled by fluoroscopy as compared with arthroscopically assisted reduction ("fracturoscopy") in patients with complex tibial plateau fractures (AO/OTA 41-C). Quality of fracturoscopy-guided reduction was checked with postoperative computed tomography. DESIGN: Prospective observational study. SETTING: Urban level 1 trauma center. PATIENTS: Seventeen consecutive patients, with a complex, bicondylar tibial plateau fracture. INTERVENTION: The intraoperative, open insertion of an arthroscope (2.4-mm or 2.8-mm optics), to visualize the articular surface and fracture reduction. MAIN OUTCOME MEASUREMENTS: Ability to detect residual fracture depression or gap after previous open reduction under fluoroscopic guidance. RESULTS: An open fracture reduction with fluoroscopic guidance was performed in all cases. In 7 cases, open reduction and fluoroscopy resulted in satisfactory fracture reduction (fluoroscopy group). In 10 of 17 cases, subsequent "fracturoscopy" showed persistent fracture depression (≥2 mm, fracturoscopy group) with the need for intraoperative correction. Patients in the fracturoscopy group demonstrated significantly greater preoperative fragment depression (12.55 ± 6.56 mm) and a larger preoperative fracture gap (7.83 ± 5.49 mm) compared with patients with a satisfactory reduction under fluoroscopy (depression 4.97 ± 4.02 mm, P = 0.016; gap 2.47 ± 1.07 mm, P = 0.023). Fluoroscopy was not successful in achieving satisfactory reduction in cases in which the postero-latero-central region was affected (P = 0.004, χ test). Postoperative computed tomography demonstrated satisfactory articular reconstruction in all cases. CONCLUSIONS: Intraoperative fracturoscopy permitted a significantly improved visualization of fracture fragment displacement, specifically in the postero-latero-central region of the tibial plateau, as compared with fluoroscopy. Fracturoscopy is recommended for fractures involving the postero-latero-central region of the tibial plateau. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Authors: Donald Adams; Jay N Patel; Vineet Tyagi; Richard S Yoon; Frank Liporace Journal: Knee Surg Sports Traumatol Arthrosc Date: 2018-09-12 Impact factor: 4.342
Authors: Abdullah Al Sultan; Mohamad Al Masri; Mohammad Weam Bolad; Muhammad Al Atrash; Mohammad Alsultan Journal: Ann Med Surg (Lond) Date: 2022-06-08
Authors: Mary Kate Erdman; Stephen J Gibbs; Douglass W Tucker; Adam K Lee; Mark E Fleming; Geoffrey S Marecek Journal: Eur J Orthop Surg Traumatol Date: 2021-09-23