**4.1 Asociated meniscal and ligamentous lesions**

Diagnosis and immediate treatment of associated meniscal lesions by partial meniscectomy and debridement can be performed during initial arthroscopy. These may account for a lower incidence of degenerative changes in arthroscopically treated fractures cases. The collateral ligaments sprains do not require surgical treatment. They can be futher protected during mobilisation with an articulated cast-brace or a rehabilitation brace when the joint immobilisation is not necessary. The ACL lesions are reevaluated after the fracture healing and late reconstruction could be necessary.

Various lessions of soft tissue are associated with tibial plateau fractures. These are usually neglected by most traumatic surgeons. All the meniscus lessions type, capsular disruption, intraarticular haematomas, osteochondral small fragments, ACL various lessions or collateral ligaments are associated with tibial plateau fractures.

Based on the OR findings, in our opinion, the following classification of soft tissue lessions should be added to each type of Schatzker fractures:


228 Modern Arthroscopy

Indirect reduction techniques have the advantage of minimal soft tissue striping and fragment devitalization (Kenneth A.E.& Kenneth J. K., 2006). For badly comminuted fractures an external fixator is used such as femoral – tibial distractor, eventually articulated. Closed methods are prefered in order to elevate depressed fragments, which can be carried out under fluoroscopic or arthroscopic guidance (Buchko & Johnson, 1996; Cristea et al., 2010). Bone tamps are placed under image and the depressed segments are elevated. Accuracy of reduction may be checked with the aid of the arthroscope. In type IV-VI because there are significant forces, lag screws alone are not sufficient to stabilize these

Fig. 3. External fixator and minim invasive reduction under X ray and arthroscopic control –

Fig. 4. Minim invasive reduction under X ray and arthroscopic control – intraoperative

Diagnosis and immediate treatment of associated meniscal lesions by partial meniscectomy and debridement can be performed during initial arthroscopy. These may account for a lower incidence of degenerative changes in arthroscopically treated fractures cases. The

**4.1 Asociated meniscal and ligamentous lesions** 

fractures and external fixation is used.

intraoperative aspects

aspects


Fig. 5. Minim invasive reduction of complex fracture which includes the spinal plateau. X ray and Arthroscopic control – after reduction

### **4.2 Author's experience and statistical analysis**

Between 2006-2010 we had 398 tibial plateau fractures and for 262 we used surgical treatment. Of those 68% were external plateau fractures; 18% were internal plateau fractures and 14% were bilateral plateau fractures. We saw a great discrepancy between radiology and CT. On the Xray and CT we follow and appreciate the deplacement degree, fracture's type and indication of treatment (Tscherne & Lobenhoffer, 1993).

We obtained very good results in 80% of cases, but also we have one case with infection after a month which neccessitate extraction of the screws and wires; in 15% of cases we obtained a mobility of the knee around 95-105 degree of fexion; in 4% of cases we were not able to restore the entire surface of the tibial plateau.

The Role of Arthroscopy in Mini-Invasive Treatment of Tibial Plateau Fractures 231

Table 2. Short term results of the tibial plateau fractures

The statistical analysis was obtained with the use of SASTM computer software, version 9.1.3, Cary U.S. To compare the subgroups on the basis of quantitative variables, a Student test was used. For the qualitative variables, a Pearson's Khi2 was used or a Fisher's exact test if the theoretical numbers were too low.. The degree of significance chosen for the overall risk of the first case was fixed at 5 % in both situations.

In our study several international systems of evaluation were used (KOOS scores, IKS, Lysholm, Tegner and Rasmussen) thus permiting a comparison with a larger number of literature series. In general our functional results were satisfying and comparable to other series.


In table 1 and 2 we compare our results with other international studies in literature.

ACL : anterior cruciate ligament ; IKS : International Knee Society.

Table 1. Mean results of tibial plateau fractures.

The statistical analysis was obtained with the use of SASTM computer software, version 9.1.3, Cary U.S. To compare the subgroups on the basis of quantitative variables, a Student test was used. For the qualitative variables, a Pearson's Khi2 was used or a Fisher's exact test if the theoretical numbers were too low.. The degree of significance chosen for the

In our study several international systems of evaluation were used (KOOS scores, IKS, Lysholm, Tegner and Rasmussen) thus permiting a comparison with a larger number of literature series. In general our functional results were satisfying and comparable to other

> Cassard, 1999

Rossi,2008 Siegler,

— — — 25,5 9

2009

Our series, 2010

In table 1 and 2 we compare our results with other international studies in literature.

Number of patients 52 44 57 28 262 Number of follow-up patients 38 44 46 21 184 Average age 47 46 48 43 51 Average follow-up (months) 62 69 60 59,5 60 Associated lessions (%) 53,8 — 39 32,1 63 Meniscal lesions (%) — — 28 7,1 53 ACL Lessions (%) — — 11 3,6 10

complications (%) 15,4 — 3,5 0 4,9 IKS average — 92 93,2 85,2 93 IKS functional average — 96 94, 8 91 95 Clinical Rasmussen average — — 28,2 25,5 9

Arthrosis Xray (%) 28,9 20 8,6 47,6 25 Malalignment (%) 15,8 — 8,7 32,1 4,9

ACL : anterior cruciate ligament ; IKS : International Knee Society.

Table 1. Mean results of tibial plateau fractures.

Scheerlin C.K., 1998

Fig. 6. X ray Pre and postoperative aspects

series.

Postoperative

average

Radiological Rasmussen

overall risk of the first case was fixed at 5 % in both situations.


Table 2. Short term results of the tibial plateau fractures

The Role of Arthroscopy in Mini-Invasive Treatment of Tibial Plateau Fractures 233

In general, walking with crutches with minimal load bearing is possible after a few days. In simple fractures, or stable construct fixation full bearing is allowed at 10-12 weeks. The articulated cast braces or rehabilitation braces can be usefull in early rehabilitation. Secondary, progressive impaction of the depressed zone can occur due to weight bearing, even 4 to 5 months postoperatively, especially in obese patients or those with ostheoporotic

The risk of infection is reduced due to: shortened time of surgery, minimal dissection, extraperiosteal dissection, minimal size of implants, antibiotics. The implants ablation and antibiotics resolve that rare complication, while in classical open surgery the rate of

Fig. 8. X ray Pre and postoperative aspects

**5.3 Weight-bearing** 

**6. Complications** 

infections and stiffness is 10 %.

bone.

ACL : anterior cruciate ligament ; IKS : International Knee Society.

We reduced the infection rate by:


We use anticoagulant therapy for thrombembolism profilaxy. There were no DVT or pulmonary embolism (PE) complications in our series. There was no compartmental syndrome in our series due to low pressure during joint irrigation in arthroscopy, no pump was used.
