Arthroscopic Treatment of Tibial Plateau Fractures John F. Meyers, M.D.
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Transcript of Arthroscopic Treatment of Tibial Plateau Fractures John F. Meyers, M.D.
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Arthroscopic Treatment of Tibial Plateau Fractures
Arthroscopic Treatment of Tibial Plateau Fractures
John F. Meyers, M.D.John F. Meyers, M.D.
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AdvantagesAdvantages
• Visualize Fracture
• Remove Clot & Bone Fragments
• Identify & Treat Other Pathology
• Visualize Fracture
• Remove Clot & Bone Fragments
• Identify & Treat Other Pathology
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AdvantagesAdvantages
• Reduce Fracture Under Direct Visualization
• Minimize Soft Tissue Damage
• Reduce Fracture Under Direct Visualization
• Minimize Soft Tissue Damage
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IndicationsIndications
• Hohl Type I, II & III
• Selected Type IV & V
• Hohl Type I, II & III
• Selected Type IV & V
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OR SetupOR Setup
• General Anesthesia
• Supine Position
• Leg Holder High on Thigh
• General Anesthesia
• Supine Position
• Leg Holder High on Thigh
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OR SetupOR Setup
• Tourniquet
• Image Intensifier
• Tourniquet
• Image Intensifier
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Arthroscopic InspectionArthroscopic Inspection
• Scope Anterolateral
• Medial Outflow
• Irrigate Joint
• Scope Anterolateral
• Medial Outflow
• Irrigate Joint
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Arthroscopic InspectionArthroscopic Inspection
• Remove Clot & Bone Fragments
• Evaluate & Treat Associated Ligament & Meniscal Injuries
• Remove Clot & Bone Fragments
• Evaluate & Treat Associated Ligament & Meniscal Injuries
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Fracture ReductionFracture Reduction
• Transverse Drill Holes
• Drive Osteotome Under Fracture
• Elevate Fracture
• Transverse Drill Holes
• Drive Osteotome Under Fracture
• Elevate Fracture
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FixationFixation
• 6.5mm Cannulated Cancellous Screws
• 6.5mm Cannulated Cancellous Screws
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Bone GraftBone Graft
• Allograft
• Autograft
• Allograft
• Autograft
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Post OpPost Op
• Quad & Hamstring Exercises
• Non-weight Bearing Until Fracture Healed
• Quad & Hamstring Exercises
• Non-weight Bearing Until Fracture Healed
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Post OpPost Op
• CPM While in Hospital
• Hinged Brace
• CPM While in Hospital
• Hinged Brace
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The Role of Arthroscopy in the Management of Tibial
Plateau Fractures
The Role of Arthroscopy in the Management of Tibial
Plateau Fractures
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R.B. Caspari, M.D.P.M.J. Hutton, M.D.T.L. Whipple, M.D.J.F. Meyers, M.D.
R.B. Caspari, M.D.P.M.J. Hutton, M.D.T.L. Whipple, M.D.J.F. Meyers, M.D.
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30 Fractures1979 – 198430 Fractures1979 – 1984
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13 Males16 Females13 Males
16 Females
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Conservative ManagementConservative Management
• Closed Reduction
• Casting / Bracing
• Traction / Suspension
• Early Motion
• Closed Reduction
• Casting / Bracing
• Traction / Suspension
• Early Motion
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Operative ManagementOperative Management
• Open Reduction
• Anatomical Restoration
• Internal Fixation
• Early Motion
• Open Reduction
• Anatomical Restoration
• Internal Fixation
• Early Motion
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Mason HohlJBJS – 1967Mason HohlJBJS – 1967
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Age Range :14 – 85 YearsAge Range :14 – 85 Years
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Moore and HarveyJBJS – 1974
Moore and HarveyJBJS – 1974
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27 Acute Fractures3 Old Fractures
27 Acute Fractures3 Old Fractures
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Elstrom and PankovichJBJS 1976
Elstrom and PankovichJBJS 1976
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Soft Tissue Injuries6 Fractures
Soft Tissue Injuries6 Fractures
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Associated Soft Tissue InjuriesAssociated Soft Tissue Injuries
• Ligaments
• Meniscus
• Articular Cartilage
• Ligaments
• Meniscus
• Articular Cartilage
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Soft Tissue InjuriesSoft Tissue Injuries
• Medial Meniscus 2
• Lateral Meniscus 2
• Medial Collateral 1
• Anterior Cruciate 1
• Posterior Cruciate 1
• Medial Meniscus 2
• Lateral Meniscus 2
• Medial Collateral 1
• Anterior Cruciate 1
• Posterior Cruciate 1
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No Significant Soft Tissue Injuries
No Significant Soft Tissue Injuries
• Cave
• Drennan, et. al.
• Moore, et. al.
• Rasmussen
• Rombold
• Cave
• Drennan, et. al.
• Moore, et. al.
• Rasmussen
• Rombold
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Soft Tissue InjuriesSoft Tissue Injuries
• Aply
• Hohl, Et. Al.
• Martin
• Roberts
• Shelton
• Aply
• Hohl, Et. Al.
• Martin
• Roberts
• Shelton
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ArthroscopyArthroscopy
• Low Risk Procedure
• Accurate Definition of Fx
• Soft Tissue Evaluation
• Low Risk Procedure
• Accurate Definition of Fx
• Soft Tissue Evaluation
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ArthroscopyArthroscopy
• Reduction of Selected Fx
• Removal of Inter-articular Debris
• Post-healing Evaluation
• Reduction of Selected Fx
• Removal of Inter-articular Debris
• Post-healing Evaluation
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Materials and MethodsMaterials and Methods
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30 Fractures29 Patients
30 Fractures29 Patients
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HospitalizationHospitalization
• Operative Group : 10 – 12 Days
• Non-operative Group : 27 Days (avg.)
• Operative Group : 10 – 12 Days
• Non-operative Group : 27 Days (avg.)
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Fracture HealingFracture Healing
• Non-operative Group 4 Mos
• Arthrotomy Group 4 Mos.
• Arthroscopy Group 1.8 Mos.
• Non-operative Group 4 Mos
• Arthrotomy Group 4 Mos.
• Arthroscopy Group 1.8 Mos.
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Arthroscopy After Fracture Healing4 Cases
Arthroscopy After Fracture Healing4 Cases
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Arthroscopy After Fracture Healing
Arthroscopy After Fracture Healing
• Mytosis Ossificans
• Loose Body
• Meniscectomy
• Abrasion Chondroplasty
• Mytosis Ossificans
• Loose Body
• Meniscectomy
• Abrasion Chondroplasty
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1.Arthroscopy Is of Value in the Management of Tibial
Plateau Fractures.
1.Arthroscopy Is of Value in the Management of Tibial
Plateau Fractures.
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2. Acute Fractures and Associated Soft Tissue Injuries
Can Be Precisely Defined, Allowing Timely Management
Decisions.
2. Acute Fractures and Associated Soft Tissue Injuries
Can Be Precisely Defined, Allowing Timely Management
Decisions.
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Cast ImmobilizationCast Immobilization
• Non Operative Groups : 5 wks.
• Arthrotomy Group : 4 wks.
• Arthroscopy Group : 10 days
(9 Pts. – No Immobilization)
• Non Operative Groups : 5 wks.
• Arthrotomy Group : 4 wks.
• Arthroscopy Group : 10 days
(9 Pts. – No Immobilization)
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Functional Range of Motion(10 – 100°)
Functional Range of Motion(10 – 100°)
• Non Operative Group 4.3 Mos.
• Arthrotomy Group 3.0 Mos.
• Arthroscopy Group 1.3 Mos.
• Non Operative Group 4.3 Mos.
• Arthrotomy Group 3.0 Mos.
• Arthroscopy Group 1.3 Mos.
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The Role of Arthroscopy in the Management of Tibial
Plateau Fractures
The Role of Arthroscopy in the Management of Tibial
Plateau Fractures
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Thank You !Thank You !
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ComplicationsComplications
• Peroneal Nerve 3
• Delayed Union 1
• Suture Abscess 1
• Peroneal Nerve 3
• Delayed Union 1
• Suture Abscess 1
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4. Healed, but Symptomatic Fractures May Benefit From
Arthroscopic Surgery
4. Healed, but Symptomatic Fractures May Benefit From
Arthroscopic Surgery
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3. Based on Direct Arthroscopic Observation, Selected
Fractures Can Be Reduced and Stabilized, and Appropriate Post-operative Management
Determined.
3. Based on Direct Arthroscopic Observation, Selected
Fractures Can Be Reduced and Stabilized, and Appropriate Post-operative Management
Determined.
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The Role of Arthroscopy in the Management of Tibial
Plateau Fractures
The Role of Arthroscopy in the Management of Tibial
Plateau Fractures
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Moore and HarveyJBJS – 1974
Moore and HarveyJBJS – 1974
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30 Fractures1979 – 198430 Fractures1979 – 1984
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Elstrom and PankovichJBJS – 1976
Elstrom and PankovichJBJS – 1976
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Conservative ManagementConservative Management
• Closed Reduction
• Casting / Bracing
• Traction / Suspension
• Early Motion
• Closed Reduction
• Casting / Bracing
• Traction / Suspension
• Early Motion
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Operative ManagementOperative Management
• Open Reduction
• Anatomical Restoration
• Internal Fixation
• Early Motion
• Open Reduction
• Anatomical Restoration
• Internal Fixation
• Early Motion
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Mason HohlJBJS – 1967Mason HohlJBJS – 1967
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Associated Soft Tissue InjuriesAssociated Soft Tissue Injuries
• Ligaments
• Meniscus
• Articular Cartilage
• Ligaments
• Meniscus
• Articular Cartilage
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30 Fractures29 Patients
30 Fractures29 Patients
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Materials and MethodsMaterials and Methods
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ArthroscopyArthroscopy
• Low Risk Procedure
• Accurate Definition of Fx
• Soft Tissue Evaluation
• Low Risk Procedure
• Accurate Definition of Fx
• Soft Tissue Evaluation
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Soft Tissue InjuriesSoft Tissue Injuries
• Aply
• Hohl, Et Al.
• Martin
• Roberts
• Shelton
• Aply
• Hohl, Et Al.
• Martin
• Roberts
• Shelton
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ResultsResults
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Fracture TypesFracture Types
Type I 10Type II 1Type III 8Type IV 3Type V 1Type VI 7
Type I 10Type II 1Type III 8Type IV 3Type V 1Type VI 7
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ARIF/GraftingARIF/Grafting
Type I 4
Type II 1
Type III 8
Type IV 1
Type V 1
Type I 4
Type II 1
Type III 8
Type IV 1
Type V 1
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PatientsPatients
• Arthroscopic Surgery 17• Arthrotomy (Alone) 4• Arthroscopy and Arthrotomy 3
• Arthroscopic Surgery 17• Arthrotomy (Alone) 4• Arthroscopy and Arthrotomy 3
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Arthroscopic ProceduresArthroscopic Procedures
Diagnostic Exam 7
Debridement 3
Partial Meniscectomy 2
Closed Reduction 1
ARIF and / or Graft 14
Diagnostic Exam 7
Debridement 3
Partial Meniscectomy 2
Closed Reduction 1
ARIF and / or Graft 14
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Arthroscopy and ArthrotomyArthroscopy and Arthrotomy
• ARIF / Meniscus Repair
• Arthroscopy / ORIF
• ORIF / Arthroscopy
• ARIF / Meniscus Repair
• Arthroscopy / ORIF
• ORIF / Arthroscopy
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A.R.I.F. / B.G.A.R.I.F. / B.G.
• AR and BG 2• ARIF 8• ARIF and BG 3• ARIF and PMM 1
• AR and BG 2• ARIF 8• ARIF and BG 3• ARIF and PMM 1
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Surgery – 24 PatientsNo Surgery – 5 PatientsSurgery – 24 Patients
No Surgery – 5 Patients