Augmentation of fracture fixation
Peter V. Giannoudis, Thomas A. Einhorn in Surgical and Medical Treatment of Osteoporosis, 2020
Tibial plateau fractures are categorized into certain types. As described, often a depression of the articular surface is involved, with collapse of subchondral bone. This is the result of axial loading combined with valgus force. In order to restore the articular surface, the depression area needs to be elevated, and the void created underneath has to be managed (Figure 32.3a–c). The material to be used has to withstand compression forces, with the capacity to address shearing and bending forces as well. The void is usually filled with tricalcium phosphate cement or other types of autologous bone or allograft. After the graft is applied, the fracture is supported with metalwork. In the postoperative period, weight-bearing is restricted for 6–12 weeks so that the fixation stability and the restored congruency are not jeopardized. In a study involving 49 patients with an isolated tibial plateau fracture, Keating et al. fixed the void using biological cement Norian SRS. Postoperatively, the patients began weight-bearing after 6 weeks. No loss of reduction and collapse were reported (18).
Proximal tibial fractures
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
Ligamentous injuries about the knee are commonly associated with tibial plateau fractures.14,15 For example, in lateral split depression injuries or local lateral compression fractures from a valgus load on the knee, a common injury pattern in the elderly population, a medial collateral ligament (MCL) injury may occur. However the incidence of MCL injury is generally thought to be higher in patients with normal bone stock since osteopenic bone protects ligamentous structures about the knee, as failure occurs through the bone rather than soft tissue.3
A to Z Entries
Clare E. Milner in Functional Anatomy for Sport and Exercise, 2019
The knee consists of the tibiofemoral joint between the long bones of the lower extremity, where the femoral condyles articulate with the tibial plateau. The patellofemoral joint lies between the intertrochanteric groove of the femur and the patella (kneecap). The primary movement at the knee is flexion-extension in the sagittal plane (see planes and axes of movement). Typically, the knee has a range of motion of about 140° of flexion-extension, from about 5° of hyperextension to 135° of flexion. Secondary movements at the knee are abduction-adduction and internal-external rotation.
Design and application of personalized surgical guides to treat complex tibial plateau malunion
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Chi-Pin Hsu, Shang-Chih Lin, Aamer Nazir, Chen-Te Wu, Shih-Sheng Chang, Yi-Sheng Chan
Tibial plateau malunion (TPM) is a complex problem for orthopedic surgeons. When the fractured parts of the tibial plateau are depressed, the articular surfaces become unable to transmit the knee loads and increase the stress borne by the articular cartilage. Moreover, axial malalignment of the lower limb occurs, and the weight-bearing axis is shifted to the side of the depression. In cases of height differences of the articular surfaces greater than 2 mm, osteotomy and osteosynthesis are recommended to restore the anatomic position of the fracture parts and the mechanical axis of the lower limb (Abdel-Hamid et al. 2006; Huang et al. 2008; Kfuri and Schatzker 2017; Wang et al. 2017, 2018). Subsequently, the surgeon uses unilateral or bilateral internal fixation to stabilize the reconstructed configuration of the articular surfaces and enhance the bone union (Wang et al. 2017).
Open-Wedge HTO with Absorbable β-TCP/PLGA Spacer Implantation and Proximal Fibular Osteotomy for Medial Compartmental Knee Osteoarthritis: New Technique Presentation
Published in Journal of Investigative Surgery, 2021
Ruipeng Zhang, Shilun Li, Yingchao Yin, Jialiang Guo, Wei Chen, Zhiyong Hou, Yingze Zhang
Alignment correction of the varus deformity could also be accomplished without fibular osteotomy in the classical HTO procedure [13,14]. It was considered to be a biomechanically sound joint-preserving treatment for relatively younger patients with symptomatic varus knee OA. However, accurate eversion of the distal tibia to ideal alignment correction is technically demanding because of the resistance of the fibula. Furthermore, plate fixation with bone grafting may be essential to maintain the corrective effect. Secondary surgery is needed to remove the plate after the osteotomy line has healed. We previously found that fibular support for the lateral tibial plateau (asymmetrical subsidence) was the reason for medial compartmental knee OA [12]. Therefore, fibular osteotomy was applied to relieve the pain induced by mild knee OA in this study.
Monogenic forms of lipodystrophic syndromes: diagnosis, detection, and practical management considerations from clinical cases
Published in Current Medical Research and Opinion, 2019
Camille Vatier, Marie-Christine Vantyghem, Caroline Storey, Isabelle Jéru, Sophie Christin-Maitre, Bruno Fève, Olivier Lascols, Jacques Beltrand, Jean-Claude Carel, Corinne Vigouroux, Elise Bismuth
A 70-year-old Caucasian male had generalized lipoatrophic features with hyperphagia since childhood. Diabetes was diagnosed at age 28 years, without any family history of the condition. At the time, the patient’s body mass index (BMI) was 20 kg/m2. At age 55 years, the patient had severe diabetic neuropathy, and incipient nephropathy, and was receiving high doses of insulin (2.5 IU/kg/day) without achieving adequate glucose control; the patient also had marked hypertriglyceridemia (from 6 to 8 mmol/L). He presented a spontaneous fracture of the right lateral tibial plateau in the absence of any trauma, with radiographic evidence of an osteolytic lesion. At age 58 years, the patient was treated for non-Hodgkin lymphoma. At age 70 years, he was diagnosed with left carotid artery stenosis.
Related Knowledge Centers
- Compartment Syndrome
- Tibia
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- Osteoporosis
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