Journal articles on the topic 'Tibial plateau fracture'
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Rudran, Branavan, Christopher Little, Anatole Wiik, and Kartik Logishetty. "Tibial plateau fracture: anatomy, diagnosis and management." British Journal of Hospital Medicine 81, no. 10 (October 2, 2020): 1–9. http://dx.doi.org/10.12968/hmed.2020.0339.
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Tibial plateau fractures are peri-articular knee fractures of the proximal tibia. The presentation is dependent on the mechanism of injury. The tibial plateau is the bony platform of the distal half of the knee joint, and is made up of a medial and lateral condyle separated by the intercondylar eminence. The presentation of tibial plateau fractures can vary greatly as a result of the bimodal mechanism of injury and patient characteristics. The patient should be assessed for life- and limb-threatening injuries in accordance with British Orthopaedic Association Standards of Trauma guidelines. Imaging is undertaken to understand configuration of the fracture, which is classified by the Schatzker classification. Definitive management of the fracture depends on the severity, ranging from conservative to surgical management. Surgery is required for more severe tibial plateau fractures to restore articular congruity, mechanical alignment, ligamentous stability and to permit early mobilisation. Medium-term functional outcome after tibial plateau fractures is generally excellent when anatomy and stability is restored. At least half of patients return to their original level of physical activity. Surgical management of tibial plateau fractures is not without complication. Risk factors include postoperative arthritis, bicondylar and comminuted fractures, meniscal removal, instability, malalignment and articular incongruity. Tibial plateau fractures account for 1% of all fractures, and typically occur either as a fragility fracture or secondary to a high-energy impact. These latter injuries are associated with extensive soft tissue injury, life- and limb-threatening complications and long-term sequelae. While outcomes are generally good, severe injuries are at higher risk of infection and post-traumatic arthritis requiring knee arthroplasty. This article considers the anatomy, diagnosis and evidence-based management strategies for tibial plateau fracture.
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Walia, Palak, and Amna Diwan. "Lateral Tibial Plateau with Peroneal Nerve Entrapment is Unique Fracture in Diagnosis and Management." Orthopedics Research and Traumatology – Open Journal 5, no. 1 (December 19, 2020): 17–20. http://dx.doi.org/10.17140/ortoj-5-119.
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A majority of tibial plateau fractures involve the lateral plateau. Posterolateral tibial plateau fractures are caused by a valgus force that impacts the posterolateral plateau against the lateral femoral condyle. We describe a unique case of a patient who sustained a lateral plateau fracture with posterior displacement behind a fractured fibular head, with entrapment of the peroneal nerve. This unusual fracture pattern required dual anterolateral and lateral approach for reduction and fixation.
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Picavet, Pierre P., Bernard Bouvy, Martin Hamon, Michael Lefebvre, and Marc Balligand. "Use of Epiphysiodesis as Treatment for a Proximal Physeal Tibial Fracture in a Dog." VCOT Open 02, no. 01 (January 2019): e55-e59. http://dx.doi.org/10.1055/s-0039-1692170.
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Objective The aim of this study was to describe the use of epiphysiodesis by the means of a screw to treat a proximal tibial Salter–Harris II fracture associated with a tibial tuberosity avulsion in a 4.5-month-old Airedale Terrier. Study design A healing proximal tibial epiphyseal fracture was observed after a 10-day period. Tibial plateau angle was 40°. The fracture was treated by the insertion of a fluoroscopy-guided 3.5-mm cancellous screw. Results Successful healing of fractures and levelling of tibia plateau were obtained. Final tibial plateau angle was 8°. At long-term follow-up (18 months), owners reported sustained and full functional recovery. Conclusion Prior to ossification of the proximal tibial physis, epiphysiodesis with a screw can be used as a treatment of sub-acute, moderately displaced, Salter–Harris I or II fractures.
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Samsami, Shabnam, Robert Pätzold, Martin Winkler, Sven Herrmann, and Peter Augat. "The effect of coronal splits on the structural stability of bi-condylar tibial plateau fractures: a biomechanical investigation." Archives of Orthopaedic and Trauma Surgery 140, no. 11 (March 26, 2020): 1719–30. http://dx.doi.org/10.1007/s00402-020-03412-8.
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Abstract Introduction Surgical treatment of bi-condylar tibial plateau fractures is still challenging due to the complexity of the fracture and the difficult surgical approach. Coronal fracture lines are associated with a high risk of fixation failure. However, previous biomechanical studies and fracture classifications have disregarded coronal fracture lines. Materials and methods This study aimed to develop a clinically relevant fracture model (Fracture C) and compare its mechanical behavior with the traditional Horwitz model (Fracture H). Twelve samples of fourth-generation tibia Sawbones were utilized to realize two fracture models with (Fracture C) or without (Fracture H) a coronal fracture line and both fixed with lateral locking plates. Loading of the tibial plateau was introduced through artificial femur condyles to cyclically load the fracture constructs until failure. Stiffness, fracture gap movements, failure loads as well as relative displacements and rotations of fracture fragments were measured. Results The presence of a coronal fracture line reduced fracture construct stiffness by 43% (p = 0.013) and decreased the failure load by 38% from 593 ± 159 to 368 ± 63 N (p = 0.016). Largest displacements were observed at the medial aspect between the tibial plateau and the tibial shaft in the longitudinal direction. Again, the presence of the coronal fracture line reduced the stability of the fragments and created increased joint incongruities. Conclusions Coronal articular fracture lines substantially affect the mechanical response of tibia implant structures specifically on the medial side. With this in mind, utilizing a clinically relevant fracture model for biomechanical evaluations regarding bi-condylar tibial plateau fractures is strongly recommended.
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Arvanitakis, Alexandra V., Kerry C. Mian, Raymond Kreienkamp, and Charles E. Rhoades. "Tibial Plateau Fracture Following Low Energy Fall in the Rocky Mountains." Kansas Journal of Medicine 12, no. 3 (August 21, 2019): 91–93. http://dx.doi.org/10.17161/kjm.v12i3.11800.
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Tibial plateau fractures are debilitating injuries. They can occurin younger individuals who sustain a high energy trauma or, withincreasing age, lesser degrees of trauma and underlying bone pathology such as osteoporosis, metabolic bone disease, and malignancy.1Outside these cases, tibial plateau fractures are relatively uncommon.However, these fractures can occur in healthy patients who have sustained direct trauma to the knee.Fractures of the tibial plateau often are classified according to theSchatzker or AO classification systems.2,3 These systems evaluate theinvolvement of both the medial and lateral plateaus, degree of comminution, extension into the joint, and displacement (both articularsurfaces and the relationship of the diaphysis to the metaphysis).Most tibial plateau fractures occur in the lateral aspect of the tibialplateau.1 The increased frequency of lateral fractures is due to themedial tibial plateau being able to resist higher weight-bearing loaddue to the presence of more cancellous bone. More importantly, thelateral plateau has more articular surface exposed during extensioncompared to the medial plateau, which increases likelihood of injury.4The standard of care for most displaced tibial plateau fracturesis surgical management with open reduction and internal fixation(ORIF).5 Conservative management, such as leg bracing, is an optionfor fractures that are nondisplaced or in patients too fragile for surgical intervention. In the senior population, a total knee arthroplasty(TKA) is a less common option. Tibial plateau fractures, particularlymedial tibial plateau fractures, caused by direct trauma in the elderly,non-osteoporotic population are uncommon.We present the case of an active male without overt risk for severefracture (10-year fracture risk of 10% via FRAX score) who wasworking to repair a trail in the Rocky Mountains. While other injurieswere more likely given the mechanism of injury and patient risk, thiscase highlighted the importance of considering tibial plateau fracture,even in atypical settings without significant risk. Improved awarenessof this mechanism of injury will lead to more accurate diagnosis andgreater post-injury management.
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Jiang, Liangjun, Haobo Wu, and Shigui Yan. "Two Cases of Contact Anterior Cruciate Ligament Rupture Combined with a Posterolateral Tibial Plateau Fracture." Case Reports in Orthopedics 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/250487.
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Background.The combined occurrence of ACL rupture with a posterolateral tibial plateau fracture has not yet been reported. Two cases of such injuries have been treated in our department for the past three years.Findings.The two patients both suffered injuries from traffic accidents. The radiological examinations showed a ruptured ACL with fracture of the posterolateral tibial plateau. Reconstruction of the ACL was performed via a standard anatomical single bundle ACL reconstruction technique with autologous tendon by arthroscopy. A posterolateral tibia plateau approach was used to reduce and fix the fractured area with the aid of lag screws. After a one-year follow-up, the two patients recovered well and physical examinations showed full knee range of motion with no evidence of ACL instability.Conclusions.The cause of this type injury of ACL rupture with a posterolateral tibial plateau fracture was thought to be by a violent internal tibial rotation/anterior tibial translation without any valgus or varus knee force mechanism during the accident. Satisfactory clinical results were achieved with a standard anatomical single bundle ACL reconstruction by arthroscopy and ORIF for the posterolateral plateau fracture. Both patients reported excellent knee function and fracture healing.
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Taylor, Shea K., Andrew Sephian, and Timothy Clader. "Intraoperative tibial plateau fracture during bone preparation in a cruciate retaining primary total knee arthroplasty." BMJ Case Reports 13, no. 9 (September 2020): e233826. http://dx.doi.org/10.1136/bcr-2019-233826.
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Intraoperative fractures are a rare complication in total knee arthroplasty. Limited literature exists in regard to the incidence, mechanism of injury and management of intraoperative fractures. The authors report a unique case of an 80-year-old man who sustained a medial tibial plateau fracture that occurred intraoperatively during final tibia bone preparation with the use of the Woolley Tibia Punch (Innomed, Savannah, Georgia, USA). The fracture was managed with the addition of 4.5 mm cortical lag screws and the addition of a stemmed tibial implant to bypass the fracture. This is the first reported case in literature that describes an intraoperative medial tibial plateau that occurred through the use of a Woolley Tibia Punch. The authors recommend the consideration of drilling to prepare sclerotic bone for cement penetration rather than a punch in order to minimise the potential for intraoperative fractures that may occur with the use of a punch.
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Kamineni, Srinath. "Tibial Plateau Fracture." Orthopedics 25, no. 8 (August 2002): 858–59. http://dx.doi.org/10.3928/0147-7447-20020801-18.
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Graham, Patrick. "Tibial Plateau Fracture." Orthopaedic Nursing 36, no. 4 (2017): 303–5. http://dx.doi.org/10.1097/nor.0000000000000373.
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Koya, Harikrishna, Kalyan Kumar, T. Upendra, Riyaz Sheik, and K. Satya Kumar. "FUNCTIONAL OUTCOME OF COMMINUTED PROXIMAL TIBIAL FRACTURE TREATED BY LOCKING PLATE." International Journal of Research -GRANTHAALAYAH 8, no. 11 (December 8, 2020): 227–36. http://dx.doi.org/10.29121/granthaalayah.v8.i11.2020.2440.
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Most common intraarticular fractures in knee joint are tibial plateau fractures result from indirect coronal or axial compression forces. Tibial plateau fractures constitute 1% of all fractures in the human body and 8% fractures in the older people (1). Tibial plateau fractures include varied configuration of fracture pattern involving of medial condyle (10-23%), lateral condyle (55-70%), in both (11-30%) with variable articular depression. Improper restoration of plateau fracture fragments leads to axis deviation and deformity and premature.
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Deshmukh, Mithushi. "REHABILITATION OF A 60-YEAR-OLD WOMAN’S TIBIAL PLATEAU FRACTURE." Journal of Medical pharmaceutical and allied sciences 10, no. 4 (September 15, 2021): 3229–32. http://dx.doi.org/10.22270/jmpas.v10i4.1284.
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Tibial plateau fracture is one of the commonest fractures which leads to the break in the continuity of the upper part of the tibia (shinbone) that involves the knee joint. It involves either lateral tibial condyle or medial tibial condyle or both. This fracture interferes with the normal functioning of the body in day-to-day life. Therefore, physiotherapy rehabilitation after surgery is essential to get back to normal functioning. A 60-year-old female who slipped from a two-wheeler started experiencing severe pain & swelling around the knee joint. Her relatives brought her to Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Wardha, Maharashtra. X-ray was done and she was diagnosed with lateral tibial condyle fracture (tibial plateau fracture) and then underwent open reduction internal fixation with plate osteosynthesis. Later, she was referred for physiotherapy rehabilitation, which aimed to restore mobility, regain full range of motion, develop muscle strength and build up to weight-bearing. The tibial plateau fracture is a form of fracture with a low occurrence and is a complicated fracture to treat.The above case study concludes that a traditional surgical procedure combined with timely planned physiotherapy rehabilitation contributed to progressive improvement in functional goals, which is an important factor in achieving a good recovery in such post-operative cases.
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Mohd, Yunus R., G. N. Solayar, and A. R. Ahmad. "POSTERO-MEDIAL TIBIAL PLATEAU (MOORE’S TYPE) FRACTURE AND THE IMPORTANCE OF COMPUTER TOMOGRAPHY IN DIAGNOSIS: A CASE REPORT." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl5 (May 1, 2020): 2325967120S0004. http://dx.doi.org/10.1177/2325967120s00044.
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Moore type I posteromedial split fracturedislocation of proximal tibia are relatively uncommon. It is a specific fracture pattern that is not well described by the AO (41B2.2/B3.2) or Schatzker (IV) classification system because these systems do not differentiate when the medial fragment is primarily posterior and associated with a dislocation as the Moore system does. 1The additional use of computed tomography scans in the assessment of tibial plateau fracture may improve surgeon’s agreement that lead to the final decision and optimization of treatment. 2Galla and Lobenhoffer described a direct posteromedial approach for managing Moore type I tibial plateau fracture1. Report: A 48 years old malay gentlemen was alleged motor-vehicle accident, sustained closed fracture tibial plateau of right knee. Initially patient was diagnosed with right tibial fracture schatzker IV based on right knee anterior-posterior and lateral view xray. But CT scan had done, show the proximal tibial fracture transversing medial aspect with coronal spliting. Patient was treated with posteromedial locking compression plate with Lobenhoffer approach. Intraoperatively, diagnosis was confirmed with Hohl & Moore classification type I, there is coronal split fracture extending to posteromedially. The importance of computerised tomography scans when dealing with intra-articular fracture of tibial plateau may improve regarding localisation of fracture lines, depression zone, comminution, and the surgical treatment plan. 2Alexander et al. reported after addition of computerised tomography scans significantly improved to “good” in all classification. The features of Moore’s type I fracture which is coronal split fracture dominantly posterior column, coronal view from CT scans is more useful compare than sagital view. Galla and Lobenhoffer have introduce a direct postero-medial approach that minimizes soft tissue injury while allowing excellent fracture visualization, reduction, and fixations. 1This technique protect the neurovascular bundle and requires only suboeriosteal elevation of the popliteus to obtain full exposure. Furthermore, because of the protecting posterior soft tissues, skin closure and wound healing are reliable. Conclusion: Moore’s type I fracture managed with postero-medial approach has better post operative outcome, improved reliability and shows good reproducibility when classified with computerised tomography scans. References: Johannes K.MF, et al,. Optimizing the Management of Moore Type I Postero-Medial Split Fracture Dislocations of the Tibial Head: Description of the Lobenhoffer Approach. J Orthop Trauma 2007;21:330-336 Alexander B, et al. Classification system for tibial plateau fractures: Does computed tomography scanning improve their reliability? Injury, Int. J. Care Injured 41 (2010) 173-178
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Kerschbaum, Maximilian, Morgane Tyczka, Lisa Klute, Marie Theres Heller, Matthias Koch, Daniel Popp, Siegmund Lang, Volker Alt, and Michael Worlicek. "The Tibial Plateau Map: Fracture Line Morphology of Intra-Articular Proximal Tibial Fractures." BioMed Research International 2021 (August 24, 2021): 1–6. http://dx.doi.org/10.1155/2021/9920189.
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The purpose of this study was to characterize the patterns of a large series of tibial plateau fractures with the use of fracture mapping, with regard to different fracture types using the OTA/AO and Schatzker classification. Patients with intra-articular fractures of the tibial plateau were evaluated, using the OTA/AO and Schatzker classification on CT scans. For fracture mapping, the axial slice that completely displayed the tibial joint plane was first identified, then matched to a template congruently, and the fracture lines were identified and reproduced. In addition to epidemiological data (age and gender), the trauma mechanism (high-energy, low-energy, and pathological fracture) was recorded. In total, 271 patients with 278 intra-articular fractures of the tibial head were analyzed, including seven patients with both sides affected. The mean age was 49.1 years (men 46.3 years, women 53.5 years). The majority of fractures was caused by high-energy trauma. No significant difference could be shown with respect to trauma mechanism and resulting fracture type in terms of OTA/AO ( p = 0.352 ) or Schatzker classification ( p = 0.884 ). A significant difference could be found with respect to gender and resulting fracture type in terms of OTA/AO ( p = 0.031 ). 170 (61.2%) were OTA/AO type B fractures, and 108 (38.8%) were type C fractures. Using the Schatzker classification, we found 53 type I (19.1%), 60 type II (21.6%), 27 type III (9.7%), 32 type IV (11.5%), 16 type V (5.8%), and 90 type VI (32.4%) fractures. The main affection was found in the lateral and intermedial column of the tibial plateaus, concerning both OTA/AO and Schatzker classification. The variability of intra-articular tibial head fractures is very high. In consequence, an individual analysis of fracture patterns and therapy planning by using CT scans is crucial.
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Bernholt, David L., Nicholas N. DePhillipo, Matthew D. Crawford, Zachary S. Aman, W. Jeffrey Grantham, and Robert F. LaPrade. "Incidence of Displaced Posterolateral Tibial Plateau and Lateral Femoral Condyle Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear." American Journal of Sports Medicine 48, no. 3 (January 9, 2020): 545–53. http://dx.doi.org/10.1177/0363546519895239.
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Background: Bone bruising of the posterolateral tibial plateau and the lateral femoral condyle sulcus terminalis has a well-established association with anterior cruciate ligament (ACL) tears. Impaction fractures of the femur and tibia may occur in these locations; however, there is a paucity of literature describing these fractures. Purpose: The primary objective was to quantify the incidence, size, and location of impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with primary ACL tears. The secondary objective was to investigate the association between impaction fractures and concomitant meniscal and ligamentous injuries. Study Design: Case series; Level of evidence 4. Methods: Patients with available magnetic resonance imaging (MRI) scans who were treated for primary ACL tear by a single surgeon were identified. MRI scans were reviewed with denotation of posterolateral tibial and femoral condylar contusions and displaced impaction fractures. Measurements of the lateral tibial plateau were taken in all patients with displaced lateral tibial plateau fractures and in a subset of control patients without tibial plateau fracture present to characterize the size and location of the bony lesion. Associations of impaction fractures with concomitant meniscal or ligamentous injuries were evaluated through use of chi-square testing. Results: There were 825 knees identified with available MRI scans. Lateral tibial plateau bone bruising was present in 634 knees (76.8%), and lateral femoral condyle bone bruising was present in 407 knees (49.3%). Posterolateral tibial plateau impaction fractures were present in 407 knees (49.3%), and lateral femoral condylar impaction fractures were present in 214 knees (25.9%). Patients with posterolateral tibial plateau impaction fractures were older than patients without these fractures (42.6 vs 32.7 years; P < .001), whereas patients with lateral femoral condylar impaction fractures were younger (23.8 vs 32.7 years; P < .001). There were 71 knees (8.6%) with a posterolateral tibial plateau impaction fracture with greater than 10% loss of lateral tibial plateau depth, and this group had an increased incidence of lateral meniscus posterior root tears (22.1% vs 12.0%; P = .02). Conclusion: Posterolateral tibial plateau impaction fractures occurred with a high incidence (49.3%) in patients with primary ACL tears and demonstrated an increased association with lateral meniscus posterior horn root tears as their size increased. Lateral femoral condylar impaction fractures occurred in 25.9% of patients with primary ACL tears and entailed an increased incidence of lateral meniscal tears and medial meniscal ramp lesions.
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Rijal, Anubhav, and Aashish Rajthala. "Functional outcome of tibial plateau fracture managed conservatively." International Journal of Research in Orthopaedics 6, no. 3 (April 22, 2020): 447. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20201721.
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<p class="abstract"><strong>Background:</strong> Tibial plateau fractures involve the articular surface of the proximal tibia. They account for approximately 1% of adult fractures. A number of articles have been published regarding tibial plateau fracture management. Interestingly excellent results have been published concluding not all fractures of the tibial plateau require surgery and not all displaced intra-articular fractures need to be reduced surgically. In this method we used conservative method to restore normal joint anatomy, joint stability, and functional motion and avoid complications.</p><p class="abstract"><strong>Methods:</strong> This study design is prospective study including forty randomly selected cases of diagnosed tibial plateau fracture presented in Orthopaedic department of tertiary referral centre over 18 months period and treated with conservative method. The patients then were followed up and evaluation of outcome was analyzed as per modified Rasmussen clinical criteria and radiological criteria at six months.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study, tibial plateau fracture was seen more in patients of age group 31-40 (35%). Mean age being 41.25 years. There were 28 (70%) male and 12 (30%) female. Road traffic accident comprises the majority of cases (75%). Regarding radiological outcome, 41.5% had excellent result, 34.3% had good result, 8.5% had fair result and 15.7% had poor result. 84% had acceptable outcome. The Rasmussen’s functional outcome at final follow up was 46% patients had excellent result, 30% had good result, 12% had fair result and 12% had poor result. 88% had acceptable clinical outcome.</p><p class="abstract"><strong>Conclusions:</strong> Conservative management of tibial plateau is still a reliable, inexpensive and alternative treatment option with favourable functional outcome.</p>
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Orestes Oluwafemi Zoffoun, Aboubacar Lawan Abdou, Saber Zari, Hicham Yacoubi, and Abdeljaouad Najib. "Assessment of intra-articular tibial plateau fractures by the three-dimensional revised Schatzker classification: Study of 94 cases." World Journal of Advanced Research and Reviews 14, no. 1 (April 30, 2022): 270–76. http://dx.doi.org/10.30574/wjarr.2022.14.1.0314.
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Background: The functional outcome of tibial plateau fractures depends a lot on stable osteosynthesis. It require an exact knowledge of the spatial configuration of the fracture. Our objective is to describe fracture plane base on computer tomography. Methods: We used Schatzker's three-dimensional classification to analyze computed tomography of patients admitted for tibial plateau fractures at the University Hospital Center of Oujda between January 2012 and August 2020. Results: We found 94 fractures, mostly type II and VI with 3 unclassifiable fractures. The anterolateral compartment is the most often affected. The overall tibial plateau coronal fracture lines was 14.89% and is most common among type IV. Conclusion: Characterization of complex tibial plateau fractures with use of the main shear presented in this study may be more reliable for communication among surgeons, comparison of studies, preoperative planning and guiding the surgical approach and specific fixation techniques.
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Wang, Zhangfu, Binbin Zheng, Yanjun Jin, Guangyong Yang, Guofu Chen, Junbo Liang, Xiaobo Zhou, and Xiangdong Yang. "Arthroscopy-assisted surgery: The management of posterolateral tibial plateau depression fracture accompanying ligament injury: A case series and review of the literature." Journal of Orthopaedic Surgery 28, no. 1 (December 26, 2019): 230949901989120. http://dx.doi.org/10.1177/2309499019891208.
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Tibial plateau fractures are multiple fracture patterns associated with soft-tissue injuries. Among which, the combined existence of posterolateral tibial plateau depression fracture with anterior cruciate ligament (ACL) rupture has been reported rarely. Meanwhile, surgical method for the treatment of depression fracture is fairly complex. The aim of this article is to show a case series of this unusual injury pattern and the therapy of posterolateral tibial plateau depression fracture accompanying ACL rupture. In our treatment, arthroscopy assisted reduction of depression fracture and ACL reconstruction reduces surgical trauma and leads to good functional recovery. We also review the current literature.
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Liu, Yue, Yan Zhang, Xu Liang, Jin Shao, Zisheng Ai, and Tieyi Yang. "Relative Incidence of Proximal Fibula Fractures with Tibial Plateau Fractures: An Investigation of 354 Cases." Journal of Knee Surgery 33, no. 06 (March 1, 2019): 531–35. http://dx.doi.org/10.1055/s-0039-1681045.
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AbstractWe aimed to investigate the incidence of proximal fibula fractures in patients with tibial plateau fractures and to identify risk factors for such combined injuries. From January 2011 to December 2015, 354 patients with tibial plateau fractures who had been admitted to a level 1 trauma center were retrospectively evaluated by an orthopaedic trauma surgeon and two skeletal radiologists. Anteroposterior plain radiography and computed tomography (CT) were used to characterize the injuries, and the incidence of associated proximal fibula fractures was determined. The tibial plateau fractures were classified according to the Schatzker's and three-column classifications. Associated proximal fibula fractures were simultaneously classified with a new fibula fracture classification system. Finally, we determined whether there were statistically significant associations between the presence of a proximal fibula fracture and different types of tibial plateau fractures, as well as sex and age. Proximal fibula fractures were detected in 192 (54.24%) patients using plain radiography and in 215 (60.73%) patients using CT. Logistic regression analysis indicated an increasing trend in the incidence of fibula fractures detected by the CT-based three-column classification system as follows: “age × sex > three columns > age > single posterior column > lateral column + posterior column > medial column + posterior column > medial column + lateral column > single lateral column > single medial column.” Proximal fibula fracture associated with tibial plateau fracture is a common phenomenon worthy of attention. In women, age increases the likelihood of complex tibial plateau fractures, particularly those involving the posterolateral articular surface and diaphysis, as well as the likelihood of developing proximal fibula fractures. This s Level IV diagnostic study.
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Flautt, Warren, Joseph Miller, and Jennifer Robyn Ratcliff. "Lateral Tibial Plateau Fracture." Journal of Orthopaedic & Sports Physical Therapy 42, no. 9 (September 2012): 819. http://dx.doi.org/10.2519/jospt.2012.0416.
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Sibai, Tarek, William Ricci, and Paul Tornetta. "Tibial Plateau Fracture Subluxation." Techniques in Orthopaedics 31, no. 2 (June 2016): e5-e8. http://dx.doi.org/10.1097/bto.0000000000000135.
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Brumby, Scott A., Richard Carrington, Shay Zayontz, Tim Reish, and Richard D. Scott. "Tibial plateau stress fracture." Journal of Arthroplasty 18, no. 6 (September 2003): 809–12. http://dx.doi.org/10.1016/s0883-5403(03)00330-9.
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Connolly, Leonard P., Susan A. Connolly, and S. Ted Treves. "Allograft Tibial Plateau Fracture." Clinical Nuclear Medicine 26, no. 12 (December 2001): 1035–36. http://dx.doi.org/10.1097/00003072-200112000-00011.
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Mellema, Jos J., Job N. Doornberg, Rik J. Molenaars, David Ring, and Peter Kloen. "Tibial Plateau Fracture Characteristics." Journal of Orthopaedic Trauma 30, no. 5 (May 2016): e144-e151. http://dx.doi.org/10.1097/bot.0000000000000511.
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Bernholt, David L., Nicholas N. DePhillipo, W. Jeffrey Grantham, Matthew D. Crawford, Zachary S. Aman, Mitchell Iung Kennedy, and Robert F. LaPrade. "Morphologic Variants of Posterolateral Tibial Plateau Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear." American Journal of Sports Medicine 48, no. 2 (January 3, 2020): 318–25. http://dx.doi.org/10.1177/0363546519893709.
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Background: Impaction fractures of the posterolateral tibial plateau commonly occur in the setting of anterior cruciate ligament (ACL) tears, with considerable variability found in fracture size and morphologic features. Purpose: The primary objective was to characterize different morphologic variants of posterolateral tibial plateau impaction fractures. The secondary objective was to investigate the association between these impaction fracture variants and concomitant meniscal and ligamentous injuries. Study Design: Cross-sectional study; Level of evidence 3. Methods: Patients treated for primary ACL tears and having magnetic resonance imaging available were included in this study, and magnetic resonance images were reviewed with denotation of displaced posterolateral tibial impaction fractures. A classification system was created based on morphologic variants of impaction fractures; associations were evaluated through use of independent chi-square testing. Results: There were 825 knees meeting the inclusion criteria, with displaced posterolateral tibial plateau impaction fractures present in 407 knees (49.3%). We observed 3 distinct morphologic variants of lateral tibial plateau impaction fractures: (I) posterior cortical buckle not involving the articular surface; (II) posterior impaction fracture involving the articular surface, with subtypes based on (A) tibial plateau depth bone loss <10% and (B) bone loss >10%; and (III) displaced osteochondral fragment, with subtypes for (A) shear or (B) depressed fragment. Type IIIA impaction fractures were associated with an increased incidence of lateral meniscus posterior root tears (33.3% vs 12.4%; P = .009) and an increased incidence of lateral meniscal tears (83.3% vs 56.7%; P = .024) compared with all knees without type IIIA impaction fracture. An increased incidence of medial collateral ligament (MCL) tears was noted in patients with type IIIA impaction fractures compared with those who had no fracture or had another fracture type (61.1% vs 20.1%; P < .001). Type IIIB impaction fractures were associated with an increased incidence of lateral meniscal tears (80.0% vs 56.2%; P = .005). Conclusion: A high prevalence of displaced posterolateral tibial plateau impaction fractures occur in the setting of ACL tears, and they can be classified into distinct morphologic subtypes. Posterolateral tibial plateau impaction fractures with displaced depressed or shear fragments were both associated with an increased incidence of lateral meniscal tears, whereas impaction fractures with a shear fragment were associated with an increased incidence of lateral meniscus posterior root tears and MCL tears.
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Vendeuvre, Tanguy, Olivier Monlezun, Claire Brandet, Pierre Ingrand, Isabelle Durand-Zaleski, Louis-Etienne Gayet, Arnaud Germaneau, et al. "Comparative evaluation of minimally invasive ‘tibial tuberoplasty’ surgical technique versus conventional open surgery for Schatzker II–III tibial plateau fractures: design of a multicentre, randomised, controlled and blinded trial (TUBERIMPACT study)." BMJ Open 9, no. 8 (August 2019): e026962. http://dx.doi.org/10.1136/bmjopen-2018-026962.
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IntroductionFractures of the tibial plateau are in constant progression. They affect an elderly population suffering from a number of comorbidities, but also a young population increasingly practicing high-risk sports. The conventional open surgical technique used for tibial plateau fractures has several pitfalls: bone and skin devascularisation, increased risks of infection and functional rehabilitation difficulties. Since 2011, Poitiers University Hospital is offering to its patients a new minimally invasive technique for the reduction and stabilisation of tibial plateau fractures, named ‘tibial tuberoplasty’. This technique involves expansion of the tibial plateau through inflation using a kyphoplasty balloon, filling of the fracture cavity with cement and percutaneous screw fixation. We designed a study to evaluate the quality of fracture reduction offered by percutaneous tuberoplasty versus conventional open surgery for tibial plateau fracture and its impact on clinical outcome.Methods and analysisThis is a multicentre randomised controlled trial comparing two surgical techniques in the treatment of tibial plateau fractures. 140 patients with a Schatzker II or III tibial plateau fracture will be recruited in France. They will be randomised either in tibial tuberoplasty arm or in conventional surgery arm. The primary outcome is the postoperative radiological step-off reduction blindly measured on CT scan (within 48 hours post-op). Additional outcomes include other radiological endpoints, pain, functional abilities, quality of life assessment and health-economic endpoints. Outcomes assessment will be performed at baseline (before surgery), at day 0 (surgery), at 2, 21, 45 days, 3, 6, 12 and 24 months postsurgery.Ethics and disseminationThis study has been approved by the ethics committee Ile-De-France X and will be conducted in accordance with current Good Clinical Practice (GCP) guidelines, Declaration of Helsinki and standard operating procedures. The results will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.Trial registration numberClinicaltrial.gov:NCT03444779.
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Ren, Dong, Yueju Liu, Yanxi Chen, Jian Lu, Zhaohui Song, Bing Zhou, and Pengcheng Wang. "A Novel Method of the Treatment for Posterolateral Tibial Plateau Fractures." Journal of Knee Surgery 33, no. 10 (May 24, 2019): 1010–19. http://dx.doi.org/10.1055/s-0039-1688918.
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AbstractReduction and fixation of posterolateral tibial plateau fracture via a posterolateral approach is challenging, and the posterolateral approach itself may injure the posterolateral ligament complex of the knee and can result in knee instability. We developed a new curved support plate (CSP) that can pass, via traditional anterolateral approach, through the superior tibiofibular interval and effectively support the posterolateral fragments. The purpose of our study was to determine the biomechanical reliability of the new plate and report the preliminary efficacy of the CSP for posterolateral tibial plateau fracture. In the biomechanical experiment, 40 synthetic tibias were used to create posterolateral shearing tibial fracture models, which were randomly assigned to groups A to D. Vertical displacement of the posterolateral fragments was measured under axial loads of 500 to 1,500 N. The new plate and 3.5-mm lateral locking plate exhibited similar control over fragment displacement. From June 2016 to August 2017, eight patients with posterolateral tibial plateau fracture underwent treatment with the CSP. Hospital for Special Surgery (HSS) knee score, knee flexion and extension ranges of motion, and complications were recorded to evaluate treatment effects. Eight patients (five men and three women, mean age 44 years [range, 23–66 years]) were enrolled in the study. Mean follow-up time was 13 months (range, 7–19 months). All patients achieved radiographic bone union by 3.3 months (range, 3–4 months) postoperatively. There were no complications of neurovascular injury, deep vein thrombosis, infection, and implant loosening throughout the follow-up period. At final follow-up, mean HSS score was 92.6 (88–96), with a mean knee flexion of 131.25 degrees (120–135 degrees) and a mean knee extension of 1 degree (0–5 degrees). Fixation of posterolateral tibial plateau fracture was easily and successfully achieved using our newly designed CSP, which may provide a new choice for posterolateral tibial plateau fractures.
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Thapa, Bishwamber, Prakash Sitoula, Ranjib Jha, and Santosh Thapa. "Functional outcome of column specific fixation in the management of complex tibial plateau fractures." Birat Journal of Health Sciences 7, no. 2 (November 18, 2022): 1753–57. http://dx.doi.org/10.3126/bjhs.v7i2.49293.
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Introduction: Complex tibial plateau fractures usually have complicated intra-articular fracture pattern, often associated with severe soft tissue injury and high risk of wound complications. Single or dual column plating fixation principle based upon conventional x-ray for such fractures may not address multiplanar comminution that often has posterior shearing or coronal fractures. Computed tomography based evaluation of such fractures and column specific approach allow direct fracture visualization and anatomic reduction that results in satisfactory outcome.
Objectives: To assess the clinical and functional outcome and complications of complex tibial plateau fractures fixed with column specific fixation principle.
Methodology: This prospective study was carried out from September 2019 to August 2021 in Orthopaedic department of Nobel Medical College, Biratnagar. Consecutive sampling was used among patient with complex tibial plateau fractures meeting the inclusion criteria. Among 30 patients, with closed and Gustilo grade I or II Schatzker type V-VI fractures or AO type-C injuries to the proximal tibia were operated on column specific approach and followed up for clinico-radiological evaluation.
Results: In this study, most of the patients belonged to 31-40 years of age group with mean age of 40.47 years. Majority of patients were male( 76.7%). Fracture was highly associated with road traffic accident which accounted for 83%. Fourteen patients underwent anteromedial and anterolateral plating(46.67%), 10 patients underwent anterolateral and posteromedial plating(33.33%) and remaining 6 patients underwent triple column plating(20%). The Rasmussen’s functional score at final follow up was 27.17±2.793(range 21-30). 86.7% patients had acceptable clinical outcome. The mean Rasmussen’s radiological score at final follow up was 8.97±1.217(range 6-10). Thus 93.4% patients had acceptable radiological outcome.
Conclusion: Column specific approach addresses all the fracture fragments of complex tibial plateau fractures to achieve acceptable clinical and radiological outcome.
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Soomro, Saifullah, and Zamir Ahmed Soomro. "Impacts of Circular Frame Fixator (Ilizarov) on Management of Compound fractures of proximal tibia." Pakistan Journal of Medical and Health Sciences 16, no. 11 (November 30, 2022): 117–20. http://dx.doi.org/10.53350/pjmhs20221611117.
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Aim: To determine the outcome of patients diagnosed with complex fractures of tibial plateau with associated soft tissue compromise treated by using Ilizarov fixator. Study design: Prospective observational study. Place and period of study: Orthopaedic unit, Chandka Medical College SMBBMU Larkana from January 2021 to December 2021 Methods: Patients diagnosed with complex tibial plateau fracture with associated soft tissue compromise fulfilling inclusion criteria were enrolled in study. All participants were managed with Ilizarov fixator and it was removed when fracture was united clinically and radiologically. Outcome of patients was evaluated on the basis aggregate score of knee society score and knee functional score at 6month follow up. Results: Twenty seven consecutive patients met the inclusion criteria, of which 19(70.37%) were male and 8(29.7%) were female. Average age of patients was 32.37 years. All fractures healed by the end of the 4th month. Ring fixator was removed routinely at 16th weeks after initial surgery in all patients. Transient peroneal nerve injury was found in 2 patients; no patients developed deep vein thrombosis, whereas pin site infection was most common complication and occurred in 5 patients (18.5%). According to knee society score results were excellent in 15(55.55%) patients, good in 08(29.62%) patients, fair in 03(11.11%) in patients and poor in 01(3.70%) patient. Practical implication most of proximal tibial plateau fractures with soft tissue compromise are kept under observation till the soft tissue status become favorable for open reduction and internal fixation, while fixing these type of fracture with Ilizarov fixator one can provide early relief to patients and results of this study will be help for operating surgeons while managing complex proximal tibia fractures. Conclusion: complex tibial plateau fracture can be effectively treated with Ilizarov fixation method without any complication, when exposed reduction and interior fixation with plate is contraindicated due to compromised soft tissue. Keywords: Tibial plateau, fractures, Ilizarov, fixation method, outcome, soft tissue compromise,
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Vaduva, Marcel Mihai Berceanu, Horatiu Petrescu, Rami Musallam, Abdoul Fattah Boustani, Milan Velimirovici, Dana Emilia Velimirovici, Maria Rada, Matilda Radulescu, and Delia Mira Berceanu Vaduva. "Aspect Regarding Plastic Deformations in Tibial Plateau Fractures." Materiale Plastice 55, no. 4 (December 30, 2018): 571–74. http://dx.doi.org/10.37358/mp.18.4.5076.
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Our purpose was to study tibial plateau fractures considering the rise of their incidence, their potential immediate seriousness or late complications and their complexity. We realized a clinical-statistical study concerning the incidence of tibial plateau fractures taking in account critaeria like age, sex, mechanism of injury, fracture type and correlations between these. The study involves 126 patients, 98 (77.77%) being treated surgically and 28 (22.22%) conservatory between 2008-2016 in the I-st Clinic of Orthopaedics and Traumatology Timisoara. Approximately 2/3 of cases are of Schatzker type I, II and III. Type VI Schatzker occured in 5.78% of all, the mechanism of injury being split almost equal between road accidents and falls from height. Road accidents prevale as a causing circumstance of tibial plateau fractures. 2/3 of the tibial plateau fractures associate with other significant regional lesions. Bone lesions are not rarely underestimated by plain radiographs. Therefore evacuation of haemarthrosis (showing lipohaemarthrosis) and high performance imaging (CT, MRI) are often needed. In comparison to other fracture sites, imperfect reduction of tibial plateau fractures results more frequently in long term sequellae. Being frequently complex, comminuted fractures with associated regional lesions tibial plateau fractures raise the complexity of the medical act from establishing a complete diagnosis to the final therapeutic measures. For a correct and complete preoperatory diagnosis frequently high performance imaging is needed. Tibial plateau fractures significantly affect patients, the healthcare and social-economic system, the healing and rehabilitation.
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Jafree, Syed Baqir, and Waqas Siddiqui. "Functional Outcome of Hybrid Illizarov Technique in patients with Complex Tibial Plateau Fractures." Pakistan Journal of Medical and Health Sciences 16, no. 10 (October 30, 2022): 6–8. http://dx.doi.org/10.53350/pjmhs2216106.
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Background:Tibial fractures are the most common long bone fracture, with approximately 25% being open. The majority of open tibial fractures result from a high velocity trauma, such as a motorcycle accident, or a low energy, torsional type injury, such as skiing. They are complex fractures to treat because of the lack of soft tissue coverage and blood supply of the tibial shaft. Aim: To determine the functional outcome of hybridillizarov technique in patients with complex tibial plateau fractures Study Design: Descriptive case series. Place of Study: Orthopedics Surgery Department, Jinnah Hospital, Lahore. Duration of Study: Study was carried out over a period of six months from 28-07-2021 to 28-01-2022 Methods: All the 73 patients fulfilling the selection with complex tibial plateau fractures of Schatzker's type V and VI were enrolled. Informed consent and demographic information were recorded. All the patients were evaluated for injuries, haemodynamically stabilized. Bone grafting and minimal internal fixation with cc screws was done in severely comminuted fractures. The functional results were measured by Rasmussen’s knee functional score (as per operational definition). Results: Distribution of the functional outcome of the patients was done, it showed that out of 73 patients 20(27.4%) were in excellent outcome, 41(56.2%) were in good outcome, 7(9.6%) were in fair outcome, 5(6.8%) were in poor. Conclusion: Based on our results, the use of hybrid illizarov fixation for the treatment of complex tibial plateau fractures is safe and effective in terms of low rates of complication and good functional results. Keywords: Functional outcome, Tibia plateau fracture, Hybrid ilizarov.
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Bernholt, David L., Grant J. Dornan, Nicholas N. DePhillipo, Zachary S. Aman, Mitchell I. Kennedy, and Robert F. LaPrade. "High-Grade Posterolateral Tibial Plateau Impaction Fractures in the Setting of a Primary Anterior Cruciate Ligament Tear Are Correlated With an Increased Preoperative Pivot Shift and Inferior Postoperative Outcomes After Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 48, no. 9 (July 2020): 2185–94. http://dx.doi.org/10.1177/0363546520932912.
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Background: Impaction fractures of the posterolateral tibial plateau have been previously described to occur in association with anterior cruciate ligament (ACL) tears; however, the effect of these injuries on patient-reported outcomes (PROs) after ACL reconstruction (ACLR) is not well known. Purpose: (1) To assess the effect of posterolateral tibial plateau impaction fractures on preoperative clinical knee stability assessed by the Lachman and pivot-shift examinations and (2) to assess the effect of impaction fractures on PROs after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing ACLR for primary ACL tears with available magnetic resonance imaging (MRI) scans were included in this study. MRI scans were reviewed for the presence of posterolateral tibial plateau impaction fractures, which were classified according to the morphological variant. Associations with clinical laxity determined by an examination under anesthesia were assessed using binary logistic regression. Also, 2-year postoperative PROs (12-Item Short Form Health Survey [SF-12] Mental Component Scale and Physical Component Scale [PCS], Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Tegner scores) were modeled using multiple ordinal logistic regression to assess the effect of posterolateral tibial plateau impaction fracture classification while adjusting for other covariates. Pearson correlation coefficients (PCCs) were used to assess for correlations between postoperative PROs and the amount of tibial plateau bone loss present. Results: Displaced posterolateral tibial plateau impaction fractures were present in 407 (49.3%) of 825 total knees included in this study. Knees with type IIIB impaction fractures had an increased likelihood of having a high-grade pivot shift (odds ratio, 2.3; P = .047), with no other impaction fracture types showing a significant association. There were no significant associations between posterolateral tibial plateau impaction fracture type and a higher Lachman grade. Of the 599 eligible knees with 2-year follow-up, postoperative information was obtained for 419 (70.0%). Patients improved in all PROs at a mean of 3.0 years after ACLR ( P < .001). Multiple ordinal logistic regression demonstrated a posterolateral tibial plateau impaction fracture as an independent predictor of the postoperative Lysholm score, with higher grade impaction fractures showing decreased Lysholm scores. Pearson correlation testing demonstrated weak but statistically significant correlations between sagittal bone loss of posterolateral tibial plateau impaction fractures and SF-12 PCS (PCC = –0.156; P = .023), WOMAC total (PCC = 0.159; P = .02), Lysholm (PCC = –0.203; P = .003), and Tegner scores (PCC = –0.151; P = .032). Conclusion: When classified into distinct morphological subtypes, high-grade posterolateral tibial plateau impaction fractures were independently associated with decreased postoperative outcomes after ACLR when controlling for other demographic or clinical variables. Patients with large depression-type posterolateral tibial plateau impaction fractures (type IIIB) had an increased likelihood of having high-grade pivot-shift laxity on clinical examination under anesthesia.
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Smith, Wade R., and John R. Shank. "Tibial plateau fractures: Minimally invasive fracture techniques." Operative Techniques in Orthopaedics 11, no. 3 (July 2001): 187–94. http://dx.doi.org/10.1016/s1048-6666(01)80005-7.
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Krause, Matthias, Alexander Hapfelmeier, Klaus Püschel, Miachel Amling, and Karl-Heinz Frosch. "Bone Microarchitecture of the Tibial Plateau in Health and Osteoporosis." Orthopaedic Journal of Sports Medicine 5, no. 4_suppl4 (April 1, 2017): 2325967117S0014. http://dx.doi.org/10.1177/2325967117s00141.
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Aims and Objectives: A failure rate of up to 69% of surgically treated tibial plateau fractures in the elderly is attributed among others to the increasing incidence of osteoporosis resulting in renewed immobilization and revision surgery. Hence, ideally implants are fixed in regions with sufficient bone mass. However, data on region-specific structural alterations of the tibial plateau in osteoporosis do not exist. The primary aim of the study was to characterize region-specific changes of the bone structure in patients with osteoporosis compared to skeletally healthy controls. Materials and Methods: In a preclinical case-control study twenty-one human right proximal tibiae from females with postmenopausal osteoporosis (mean age: 84.3±4.9 years) and eight skeletally healthy, premenopausal female controls (45.5±6.9 years) were harvested during autopsy. Histomorphometric parameters were assessed by HR-pQCT (high-resolution peripheral quantitative computed tomography) after digital subdivision into different volumes of interest (VOI) according to a 10-segment classification in three levels of the tibial plateau. In the coronal plane, analysis was performed in the proximal 3 cm from the articular surface. Statistical analysis was based on evolutionary learning using globally optimal regression trees. Results: Skeletally healthy controls showed a better bone structure throughout the whole tibial plateau than osteoporotic patients. In osteoporosis, the greatest bone loss was found in the medio-medial VOI (antero-medio-medial, postero-medio-medial) compared to controls. The lowest bone volume, however, was found in the central VOI (antero-central, postero-central) representing the tibial spine. Trabecular connectivity was severely reduced. Most importantly, in the anterior and posterior 25% of the lateral and medial tibial plateau, the trabecular support and the subchondral lamella thickness itself was severely reduced. Conclusion: The bone structure deterioration of the tibial plateau due to osteoporosis is region-specific. The additional thinning of the subchondral lamella and marked bone loss in the anterior and posterior 25% of the tibial plateau may explain failure of fracture reduction in cases of unilateral plate fixation, specifically in postero-medial fragments. The understanding of region-specific architectural alterations of the tibial plateau may help to improve the long-term, fracture-specific fixation of tibial plateau fractures, especially in osteoporotic patients.
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Yao, Xiang, Kaihua Zhou, Bin Lv, Lei Wang, Jun Xie, Xingli Fu, Jishan Yuan, and Yingqi Zhang. "3D mapping and classification of tibial plateau fractures." Bone & Joint Research 9, no. 6 (June 2020): 258–67. http://dx.doi.org/10.1302/2046-3758.96.bjr-2019-0382.r2.
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Aims Tibial plateau fractures (TPFs) are complex injuries around the knee caused by high- or low-energy trauma. In the present study, we aimed to define the distribution and frequency of TPF lines using a 3D mapping technique and analyze the rationalization of divisions employed by frequently used classifications. Methods In total, 759 adult patients with 766 affected knees were retrospectively reviewed. The TPF fragments on CT were multiplanar reconstructed, and virtually reduced to match a 3D model of the proximal tibia. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a tibia template. Results The cohort included 405 (53.4%) cases with left knee injuries, 347 (45.7%) cases with right knee injuries, and seven (0.9%) cases with bilateral injuries. On mapping, the hot zones of the fracture lines were mainly concentrated around the anterior cruciate ligament insertion, posterior cruciate ligament insertion, and the inner part of the lateral condyle that extended to the junctional zone between Gerdy’s tubercle and the tibial tubercle. Moreover, the cold zones were scattered in the posteromedial fragment, superior tibiofibular syndesmosis, Gerdy’s tubercle, and tibial tubercle. TPFs with different Orthopaedic Trauma Association/AO Foundation (OTA/AO) subtypes showed peculiar characteristics. Conclusion TPFs occurred more frequently in the lateral and intermedial column than in the medial column. Fracture lines of tibial plateau occur frequently in the transition zone with marked changes in cortical thickness. According to 3D mapping, the four-column and nine-segment classification had a high degree of matching as compared to the frequently used classifications. Cite this article: Bone Joint Res 2020;9(6):258–267.
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Hu, Sunjun, Shiyi Chen, Shimin Chang, Wenfeng Xiong, and Rujan Tuladhar. "Treatment of Isolated Posterolateral Tibial Plateau Fracture with a Horizontal Belt Plate through the Anterolateral Supra-Fibular-Head Approach." BioMed Research International 2020 (December 3, 2020): 1–8. http://dx.doi.org/10.1155/2020/4186712.
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The posterolateral tibial plateau fracture was not easy to be exposed and fixed with usual techniques. The aim of this study was to investigate the biomechanical stability and clinical outcome of the isolated posterolateral tibial plateau fracture fixed with a single horizontal belt plate through the anterolateral supra-fibular-head approach. Fracture models were created by 18 synthetic tibias and fixed with three different fixation modes. Each group was fixed and tested on the loading machine, and final vertical displacement of the fragment was detected and calculated. Clinically, a retrospective analysis of 12 cases of posterolateral tibial plateau fracture from January 2013 to December 2017 was performed. There were 8 males and 4 females, aged 33-72 years, with an average age of 49.6 years. Isolated posterolateral tibial plateau fractures were identified according to preoperative X-ray and computed tomography scan. Through the modified anterolateral supra-fibular-head approach, the fracture was reduced and fixed by a prebending T-shaped distal radius plate and rafting screws, with bone substitute grafting or autogenous iliac bone implantation. Patients were followed up to a minimum one year of time period, and the outcome was evaluated clinically and radiologically. The biomechanical study shows that horizontal belt plate fixation for the isolated PL tibial plateau fracture can provide sufficient stability, allowing early knee functional exercise and partial weight bearing. For clinical case series, the average operation time in this group was 73.3 ± 10.2 mins (range: 55-90), and the average duration of hospitalization was 9.1 ± 3.3 days (range: 5-16). Patients were followed up for 12-24 months with an average of 16.5 months, and all patients achieved radiological fracture union after an average of 13.7 weeks. At one year after operation, the average knee score of the Hospital for Special Surgery (HSS) scale was 93.2 ± 4.2 points(range: 90-98), the average score of SMFA was 21.1 ± 5.6 points (range: 14-31), and the average knee range of motion (ROM) was 121.48 ° ± 8.88 ° (range: 105°-135°). There were 8 cases that were very satisfied and 3 cases that were satisfied with the operation. For an isolated posterolateral tibial plateau fracture, the supra-fibular-head approach can fully expose the fracture site; the horizontal belt plate fixation of the fracture is stable and reliable to allow for early-stage knee rehabilitation, and the outcome of medium-term clinical follow-up was satisfactory.
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Schatzker, Joseph, Mauricio Kfuri, and Vincenzo Giordano. "The “Hoop” Plate for Posterior Bicondylar Shear Tibial Plateau Fractures: Description of a New Surgical Technique." Journal of Knee Surgery 30, no. 06 (September 29, 2016): 509–13. http://dx.doi.org/10.1055/s-0036-1593366.
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AbstractHigh-energy fractures of the proximal tibia with extensive fragmentation of the posterior rim of the tibial plateau are challenging. This technique aims to describe a method on how to embrace the posterior rim of the tibial plateau by placing a horizontal precontoured one-third tubular plate wrapped around its corners. This method, which we named “hoop plating,” is mainly indicated for cases of crushed juxta-articular rim fractures, aiming to restore cortical containment of the tibial plateau. Through a lateral approach with a fibular head osteotomy (Lobenhoffer approach), both anterolateral and posterolateral fragments are directly reduced and supported by a one-third tubular plate of adequate length. The plate is inserted from lateral to medial deep to all soft tissues, and its position is checked with fluoroscopy. The implant sits exactly on the posterior cortex of the tibial plateau and provides containment for the reduced juxta-articular posterior cortex and rim. We begin with immediate range of motion. Toe-touch weight-bearing with crutches is allowed with the operated knee in full extension. Weight-bearing is gradually increased only after 6 weeks as bone healing is taking place. Clinical follow-up is performed at 1, 3, 6, and 12 weeks. If the radiological exam confirms that the fracture is healed, the patient is allowed to proceed to muscle strengthening and bear weight entirely. The “hoop plating” may be a good option for the management in cases of extensive posterior tibial plateau articular surface fracture and impaction with rim and posterior cortical wall fragmentation.
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Shrestha, Bipan, Prakriti Raj Kandel, Kishor Man Shrestha, Shreshal Shrestha, and Rakesh Yadav. "Surgical Management of Tibial Plateau Fractures with Locking Compression Plate." Journal of Universal College of Medical Sciences 9, no. 01 (June 22, 2021): 18–23. http://dx.doi.org/10.3126/jucms.v9i01.37953.
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INTRODUCTION
Tibial plateau fracture is a common fracture that accounts for 1-2% of all fracture. Various treatment options including proximal tibial plating with locking compression plates are available for the treatment of tibial plateau fracture. This study was done to determine the clinical profile and functional outcome of tibial plateau fracture following locking compression plating.
MATERIAL AND METHODS
This prospective and observational study was carried out in Orthopedics Department of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH) from December 2018 to July 2020. After Ethical clearance (UCMS/IRC/224/18) from Institutional Review Board (IRB) of UCMS-TH and informed written consent, all patients with tibial plateau fracture (Schatzker II-VI) who fulfilled the inclusion criteria were enrolled in the study and treated with locking compression plate. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months for clinical, radiological and functional assessment. Descriptive statistics like frequency, percentage, mean and standard deviation were used to analyze the data.
RESULTS
In our study of 30 cases, the mean age was 37.77 ±15.65 years. Most of the cases were Schatzker type VI (13 patients) and type II (9 patients). The average duration for fractures union was 23.4 ±2.1 weeks. Superficial wound infection was the common complication seen in five cases. At six months, the mean knee society score (KSS) was 78 ±7.22 and majority of patients (19 patients) had good results.
CONCLUSION
Locking compression plate has an excellent functional and radiological outcome. It is an effective implant that can be adopted for the treatment of tibial plateau fractures in adults.
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Rabari, Yash B., Ashish M. Somanni, D. V. Prasad, and Krunal H. Thadeshwar. "Various modalities of treatment of proximal tibial fractures: a prospective longitudinal study." International Journal of Research in Orthopaedics 3, no. 2 (February 22, 2017): 259. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20170784.
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<p class="abstract"><strong>Background:</strong> Tibial plateau fractures are one of the commonest intra-articular fractures. They result from indirect coronal or direct axial compressive forces. This makes about 1% of all fractures and 8% of the fractures in elderly. Nevertheless, tibial plateau fractures challenging remain because of their number, variety and complexity. With advancements the treatment of each fracture type is still not defined hence we have taken up this study to analyze various fracture patterns and its outcome.</p><p class="abstract"><strong>Methods:</strong> The study includes 40 patients having the fractures of the proximal tibial metaphyseal; metaphyseodiaphyseal with or without intra-articular extension (including upper third fractures of tibia), closed fractures, fractures with Open grade-I wounds (Gustillo Anderson Classification).The study excludes compound fractures having grade II and III (Gustillo Anderson) and Paediatric patients. The treatment method was based on the type of fracture, the amount of displacement , the amount of depression and surrounding skin condition of the tibial plateau. We used the Schatzker classification because it is closest to describing the specific fracture type and it is easy to apply.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study there were 40 patients with mean age of 39.18 (median 38.5 and min – max 25 to 55) with 25 male (62.5%) and 15 (37.5%) female with significant male preponderance. In this study road traffic accident was the commonest mode of injury (65%) and produced different types of fractures, followed by fall from height (22.5%), injury while playing sports (12.5%).</p><p><strong>Conclusions:</strong> The correct method of management of tibial condylar fractures depends on good clinical judgment. If rational treatment is to be instituted the surgeon must have sound knowledge of the personality of the injury and a clear understanding of the knee examination, imaging studies and must be familiar with variety of techniques available at present for treating tibial condyle fractures.</p>
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Udin Hassan, Hassan. "Functional Outcome of Ilizarov Technique in Managing Proximal Tibial Fracture in Combined Military Hospital, Rawalpindi." Journal of Islamabad Medical & Dental College 11, no. 4 (January 3, 2023): 204–10. http://dx.doi.org/10.35787/jimdc.v11i4.760.
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Background: Tibial plateau fractures involve injuries affecting the major weight-bearing joint and result in functional impairment which can be prevented by implying competent treatment techniques including dual column plating, assisted reduction, internal fixation with plating and Ilizarov circular fixator. The objective of this study was to evaluate the functional outcome of Ilizarov technique in treating closed tibial plateau fractures.
Methodology: A Quasi experimental study was conducted in the Orthopedic department of Combined Military Hospital, Rawalpindi from 30th July 2019 to 29th January 2020. A total of 100 patients with tibial plateau fractures of Schatzker type III to VI, 20 to 60 years of age of either gender were included. In all patients, Ilizarov technique was performed. Data were entered in SPSS 22. Descriptive analysis was done for quantitative variables and percentages were calculated for qualitative variables. Chi square test was applied to determine association of variables with functional outcome.
Results: Mean age of patients was 37.42 ± 8.94 years. Out of 100 patients, 70% were males and 30% were females, 76% patients managed with Ilizarov technique in treating closed tibial plateau fracture had excellent functional outcome, 15% good outcome, 5% fair and 4% poor outcome. Functional outcome with respect to age, gender, BMI and DM showed statistically significant difference with p value 0.017, 0.016, 0.004 and 0.001 respectively.
Conclusion: Functional outcome of Ilizarov technique in treating closed tibial plateau fracture is significantly better.
Keywords: Ilizarov Technique, Orthopedic Fixation Devices, Tibial Fractures
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Scott Fitzgerald, M., and Marjorie J. Albohm. "The Lateral Tibial Plateau Fracture." Athletic Therapy Today 3, no. 1 (January 1998): 28–29. http://dx.doi.org/10.1123/att.3.1.28.
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Singleton, Neal, Vahe Sahakian, and Dawson Muir. "Outcome After Tibial Plateau Fracture." Journal of Orthopaedic Trauma 31, no. 3 (March 2017): 158–63. http://dx.doi.org/10.1097/bot.0000000000000762.
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DePhillipo, Nicholas, Grant Dornan, Zachary Aman, Mitchell Kennedy, Robert LaPrade, and David Bernholt. "Post-operative outcomes associated with posterolateral tibial plateau impaction fractures in the setting of primary ACL tear." Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (July 1, 2020): 2325967120S0047. http://dx.doi.org/10.1177/2325967120s00473.
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Objectives: The primary objective was to assess the effect of impaction fractures of the posterolateral tibial plateau on patient reported post-operative outcomes following primary ACL surgery. Methods: Patients with available MRI images who underwent surgery for primary ACL tears by a single surgeon between April 2010 and September 2017 were identified. A prospectively and consecutively enrolled clinical outcomes database was queried for all patients within this cohort who had 2-year or greater post-operative patient reported outcomes available. Patient reported outcomes included the 12-item Short Form Health Survery (SF-12) Physical Composite Scale (PCS) and Mental Health Composite Scale (MCS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), International Knee Documentation Committee Questionnaire (IKDC), Lysholm Knee Questionnaire, Tegner Activity Scale and patient satisfaction. For patients without existing 2-year outcomes, additional inclusion criteria included English-speaking and current age greater than or equal to 18. Patients meeting these criteria were sent electronic surveys to collect patient reported outcomes. MRI images were reviewed for all patients with denotation of displaced posterolateral tibial impaction fractures. Posterolateral tibial impactions were classified based on morphology using the following classification: (Type I) posterior cortical buckle not involving the articular surface, (Type II) posterior impaction fracture involving the articular surface [(with subtype based on (A) tibial plateau depth bone loss <10% and (B) bone loss >10%)], and (III) displaced osteochondral fragment [(with subtypes for (A) shear or (B) depressed fragment)]. All tibial impaction fractures were measured to determine amount of tibial plateau bone loss in the sagittal plane. Pre-operative and 2-year or greater post-operative patient reported outcome scales were compared based on posterolateral tibial impaction fracture classification using Kruskal-Wallis non-parametric ANOVA with Nemenyi post-hoc test. Pearson’s correlations were used to assess for correlations between post-operative patient reported outcomes and amount of tibial plateau sagittal plane bone loss present. Results: There were 638 knees identified with primary ACL tears who underwent surgery between April 2010 and September 2017. Thirty-nine patients met exclusion criteria, leaving 599 total patients. Of these, 2-year outcomes were available for 416 patients for a 69.4% follow-up rate at a mean time of 158 weeks (range: 90-422). There were statistically significant improvements in all PROs from pre-op to 2-year post-op (p < 0.001). Kruskal-Wallis non-parametric ANOVA showed no difference in all PROs based upon posterolateral impaction fracture classification type, except for Tegner Activity Scale which showed difference in outcomes based on impaction fracture type (p < .002) (Table 1). Specifically, diminished post-operative activity level was observed in patients with type 2B, type 3A, and type 3B fractures. Pearson correlation testing showed weak but statistically significant correlations between tibial plateau impaction fracture sagittal bone loss amount and SF-12 PCS (PCC: -0.156, p = 0.023), WOMAC Total Score (PCC: 0.159, p = 0.02), Lysholm (PCC: -0.203, p = .003), and Tegner Activity Scale (PCC: -0.151, p = 0.032). Independent T-testing showed no difference in any patient reported outcome scores at 2-year follow-up when all posterolateral tibial impaction fractures were grouped together compared to those without impaction fracture. Conclusion: Displaced posterolateral tibial plateau impaction fractures occurring in the setting of ACL tear are associated with diminished 2-year post-operative outcomes after ACL reconstruction. When classified based on fracture morphology, posterolateral tibial plateau impaction fracture types 2B, 3A, and 3B are associated with decreased post-operative activity level as assessed by Tegner Activity Scale. When comparing patients with posterolateral impaction fractures, greater amounts sagittal plane tibial plateau bone loss at the posterior rim showed weak but significant correlations with worse scores on SF-12 PCS, WOMAC, Lysholm, and Tegner patient reported outcome measures. [Figure: see text]
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Peltola, Erno K., Antti O. Mustonen, Jan Lindahl, and Seppo K. Koskinen. "Segond Fracture Combined With Tibial Plateau Fracture." American Journal of Roentgenology 197, no. 6 (December 2011): W1101—W1104. http://dx.doi.org/10.2214/ajr.10.6095.
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Thapa, Jagadish, Bikash Parajuli, Rohit Shrestha, Sabik Raj Kayastha, Nabaraj Acharya, and Sudarshan Pandey. "Functional Outcome and Quality of Life After Surgical Fixation of Tibial Plateau Fracture in a Tertiary Care Center of Nepal." Journal of College of Medical Sciences-Nepal 18, no. 1 (March 31, 2022): 17–26. http://dx.doi.org/10.3126/jcmsn.v18i1.43639.
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IntroductionFunctional outcome and quality of life (QoL) of patients will change following tibial plateau fracture fixation. There are limited studies evaluating functional and radiological outcomes following tibial plateau fixation in Nepal, and none has evaluated QoL. We aim to evaluate functional outcome and QoL in patients with tibial plateau fracture with a follow up period of more than two years. MethodsThis was a cross sectional, observational study done at Dhulikhel Hospital, from August 2021 to January 2022. Western Ontario and McMaster Universities Arthritis Index (WOMAC) functional outcome and World Health Organization QoL-8 (WHOQoL-8) questionnaire were filled by patients operated for tibial plateau fracture from 2011 to 2019. Compound fractures, untraceable patients, and those managed with casts were excluded from the study. ResultsThere were 121 patients (male: female = 2.3:1) with a mean age of 37.1 years. Road traffic accidents (44.6%) were the most common mode of injury, and Schatzker type IV (30.6%) was the most common type of fracture. The average WOMAC score was 13.05±12.1 and the average WHOQoL-8 score was 30.24±4.1. The average WOMAC score in high-energy and low energy trauma patients were 17.07±12.29 and 8.21±10 respectively. The average WHOQoL-8 in high energy and low energytrauma patients were 29.28±3.59 and 31.38±4.38 respectively. ConclusionsSurgical reduction and stable internal fixation of tibial plateau fractures with long term follow up has a good functional outcome and quality of life. High energy trauma is associated with poor functional outcome and quality of life.
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Tan, Lei, Yan-Hui Li, Yuying Li, Tong Lin, Dong Zhu, and Da-Hui Sun. "Tibial plateau fractures (AO type B3) combined with tibial tubercle fracture." Medicine 97, no. 36 (September 2018): e12015. http://dx.doi.org/10.1097/md.0000000000012015.
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Christiano, Anthony V., Christian A. Pean, David N. Kugelman, Sanjit R. Konda, and Kenneth A. Egol. "Function and Knee Range of Motion Plateau Six Months following Lateral Tibial Plateau Fractures." Journal of Knee Surgery 33, no. 05 (February 27, 2019): 481–85. http://dx.doi.org/10.1055/s-0039-1678676.
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AbstractThe purpose of this study is to determine when functional outcome no longer improves following tibial plateau fracture. A patient series of operatively treated tibial plateau fractures was reviewed. Patients were evaluated using the short musculoskeletal function assessment (SMFA), range of motion (ROM) assessment, and pain levels at visual analog scale (VAS) at 3, 6, and 12 months postoperatively. Fractures were classified by the Schatzker's classification using preoperative imaging. The case series was divided into two groups based on fracture patterns. Friedman's tests were conducted to determine if there were differences in SMFA, ROM, or VAS throughout the postoperative course. A total of 117 patients with tibial plateau fractures treated operatively, with complete follow-up and without complication, were identified. Seventy-seven patients (65.8%) sustained lateral tibial plateau fractures (Schatzker's I–III). Friedman's test demonstrated significant differences in SMFA (p < 0.0005) and ROM (p < 0.0005) at the three time points. Post hoc analysis demonstrated a significant difference in SMFA (p < 0.0005) and ROM (p = 0.003) between 3 and 6 months postoperatively but no significant difference in either metric between 6 and 12 months postoperatively. Friedman's test demonstrated no significant difference in VAS postoperatively (p = 0.210). Forty patients (34.2%) sustained medial or bicondylar tibial plateau fractures (Schatzker's IV–VI). Friedman's test demonstrated significant differences in SMFA (p < 0.0005) and ROM (p < 0.0005) at the three time points. Post hoc analysis demonstrated a strong trend toward significance in SMFA between 3 and 6 months postoperatively (p = 0.088), and demonstrated a significant difference between 6 and 12 months postoperatively (p = 0.013). ROM was found to be significantly different between 3 and 6 months postoperatively (p = 0.010), but no difference was found between 6 and 12 months postoperatively (p = 0.929). Friedman's test demonstrated no significant difference in VAS postoperatively (p = 0.941). In this cohort, no significant difference in function, ROM, or pain level exists between 6 and 12 months after treatment of lateral tibial plateau fractures. However, there are significant improvements in function for at least 1 year following medial or bicondylar tibial plateau fractures.
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Utomo, Dwikora Novembri, and Januar Ari Subiantoro. "CORRELATION BETWEEN THREE COLUMN CONCEPT CLASSIFICATION AND INTERNAL FIXATION PROCEDURE OF TIBIAL PLATEAU PATIENTS AT DR. SOETOMO HOSPITAL." (JOINTS) Journal Orthopaedi and Traumatology Surabaya 7, no. 1 (December 6, 2019): 1. http://dx.doi.org/10.20473/joints.v7i1.2018.1-11.
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Background: Tibial Plateau Fracture is one of the most common case seen in orthopaedics and the most classification system used is Schaetzker Classification. This classification is using X ray photograph to classify the fracture and it has limitation to describing a posterior column in tibial plateau fracture since X-ray is a 2D projection. Nowadays surgeon over the world start to using Three Column concept classification because it has a better image of 3D visualization of tibial plateau. Purpose: To know which one classification is more accurate in describing tibial plateau fracture in Dr. Soetomo Hospital period January 2015 until September 2017.Methods: This study is retrospective study, we collected data of patients with Tibial Plateau fracture that has been operated in Dr. Soetomo hospital from January 2015 – September 2017.Results: From the study found 24 patients that match with inclusion criteria. All patients are classified with Schaetzker and Three Column Classification. The most type of fracture based on Schaetzker Classification is Type 2 (7 patients) and based on Three Column Classification is type Three Column (11 patients) and the most action in Three Column type is Internal Fixation with double plate insertion (55 %).Conclusion: Three Column Classification is more accurate to describe type fracture in posterior part than Schaetzker. Three Column Classification is recommended to make easier decision for Tibial Plateau fracture treatment and prevent any loss of correction.
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Bora S., Shradha, Senthil L., Thiyagarajan U., Pradeep J. P., and Gokul Raj D. "Unusual medial tibial plateau fracture fixation using dual plating." International Journal of Research in Orthopaedics 5, no. 6 (October 22, 2019): 1113. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20194551.
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<p class="abstract"><strong>Background:</strong> Medial tibial plateau fractures is a subtype of proximal tibial fractures that involve the articular surface and can present in several distinct patterns. Purpose of this study was to assess the clinical outcome of stabilizing these biplanar medial tibial plateau fractures using dual plating technique through a single incision.</p><p class="abstract"><strong>Methods:</strong> Between 2017 to 2019, 12 men and 8 women with closed medial tibial plateau fracture who underwent reconstruction using two plates through a posteromedial approach were included in the study group. The fractures were classified using the three column concept of Lou.<strong></strong></p><p class="abstract"><strong>Results:</strong> One patient had an articular step off that was unacceptable and two patients had an acceptable articular step off. Functional assessment was done using the objective scoring of Oxford knee score criteria and radiological assessment was done using the Rasmussen modified score.</p><p class="abstract"><strong>Conclusions:</strong> Biplanar reconstruction using dual plates is a reliable and safe technique to reconstruct complex medial tibial plateau fractures.</p>
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Kolb, Jan P., Marc Regier, Eik Vettorazzi, Norbert Stiel, Jan P. Petersen, Cyrus Behzadi, Johannes M. Rueger, and Alexander S. Spiro. "Prediction of Meniscal and Ligamentous Injuries in Lateral Tibial Plateau Fractures Based on Measurements of Lateral Plateau Widening on Multidetector Computed Tomography Scans." BioMed Research International 2018 (July 29, 2018): 1–5. http://dx.doi.org/10.1155/2018/5353820.
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Background. The influence of increasing lateral plateau widening on the frequency of meniscal and ligamentous lesions in lateral tibial plateau fractures has been examined in very few studies using plain radiographs. Because the amount of this parameter cannot be measured accurately on plain radiographs, the purpose of this survey was to look for a possible correlation between the extent of lateral plateau widening, as measured on multidetector CT (MDCT) scans, and different soft-tissue injuries determined from magnetic resonance imaging (MRI). Materials and Methods. 55 patients with a lateral tibial plateau fracture were included in this retrospective case series. Patient age averaged 52.6 years (SD = 18.0). The degree of lateral plateau widening was measured on CT images. MRIs were screened for meniscal and ligamentous injuries. Results. We found a significant effect of increasing lateral plateau widening on the incidence of lateral meniscus lesions (P = 0.021), lateral collateral ligament tears (P = 0.047), and the overall quantity of meniscal and ligamentous lesions (P = 0.001). Discussion. MRIs are not widely used as a diagnostic tool in lateral plateau fractures of the tibia. Reasons might be the costs and the fact that it is a time-consuming examination. The results of this study may help to estimate the probability of specific soft-tissue lesions in lateral tibial plateau fractures based on measurements of lateral plateau widening on MDCT scans, and they may guide the decision for additional MRI and/or arthroscopically assisted repair.
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Addison, E. S., B. A. Smith, H. Radke, S. J. Hobbs, and A. M. Wallace. "Modification of the cranial closing wedge ostectomy technique for the treatment of canine cruciate disease." Veterinary and Comparative Orthopaedics and Traumatology 24, no. 06 (2011): 457–62. http://dx.doi.org/10.3415/vcot-10-11-0159.
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SummaryObjective: To describe a modification of the cranial closing wedge ostectomy (CCWO) technique and to compare its efficacy to the standard technique on cadaveric specimens.Methods: The standard and modified CCWO technique were applied to eight pairs of cadaveric tibiae. The following parameters were compared following the ostectomy: degrees of plateau levelling achieved (degrees), tibial long axis shift (degrees), reduction in tibial length (mm), area of bone wedge removed (cm2), and the area of proximal fragment (cm2).Results: The size of the removed wedge of bone and the reduction in tibial length were significantly less with the modified CCWO technique.Clinical significance: The modified CCWO has two main advantages. Firstly a smaller wedge is removed, allowing a greater preservation of bone stock in the proximal tibia, which is advantageous for implant placement. Secondly, the tibia is shortened to a lesser degree, which might reduce the risk of recurvatum, fibular fracture and patella desmitis. These factors are particularly propitious for the application of this technique to Terrier breeds with excessive tibial plateau angle, where large angular corrections are required. The modified CCWO is equally effective for plateau levelling and results in an equivalent tibial long-axis shift. A disadvantage with the modified technique is that not all of the cross sectional area of the distal fragment contributes to load sharing at the osteotomy.