arthroscopic treatment of tibial plateau fractures john f. meyers, m.d

Arthroscopic Treatment of Tibial Plateau Fractures

Arthroscopic Treatment of Tibial Plateau Fractures

John F. Meyers, M.D.John F. Meyers, M.D.

AdvantagesAdvantages

• Visualize Fracture

• Remove Clot & Bone Fragments

• Identify & Treat Other Pathology

• Visualize Fracture


• Identify & Treat Other Pathology

AdvantagesAdvantages

• Reduce Fracture Under Direct Visualization

• Minimize Soft Tissue Damage

• Reduce Fracture Under Direct Visualization

• Minimize Soft Tissue Damage

IndicationsIndications

• Hohl Type I, II & III

• Selected Type IV & V

• Hohl Type I, II & III

• Selected Type IV & V

OR SetupOR Setup

• General Anesthesia

• Supine Position

• Leg Holder High on Thigh

• General Anesthesia

• Supine Position

• Leg Holder High on Thigh

OR SetupOR Setup

• Tourniquet

• Image Intensifier

• Tourniquet

• Image Intensifier

Arthroscopic InspectionArthroscopic Inspection

• Scope Anterolateral

• Medial Outflow

• Irrigate Joint

• Scope Anterolateral

• Medial Outflow

• Irrigate Joint

Arthroscopic InspectionArthroscopic Inspection


• Evaluate & Treat Associated Ligament & Meniscal Injuries


• Evaluate & Treat Associated Ligament & Meniscal Injuries

Fracture ReductionFracture Reduction

• Transverse Drill Holes

• Drive Osteotome Under Fracture

• Elevate Fracture

• Transverse Drill Holes

• Drive Osteotome Under Fracture

• Elevate Fracture

FixationFixation

• 6.5mm Cannulated Cancellous Screws

• 6.5mm Cannulated Cancellous Screws

Bone GraftBone Graft

• Allograft

• Autograft

• Allograft

• Autograft

Post OpPost Op

• Quad & Hamstring Exercises

• Non-weight Bearing Until Fracture Healed

• Quad & Hamstring Exercises

• Non-weight Bearing Until Fracture Healed

Post OpPost Op

• CPM While in Hospital

• Hinged Brace

• CPM While in Hospital

• Hinged Brace

The Role of Arthroscopy in the Management of Tibial

Plateau Fractures


Plateau Fractures

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.

30 Fractures1979 – 198430 Fractures1979 – 1984

13 Males16 Females13 Males

16 Females

Conservative ManagementConservative Management

• Closed Reduction

• Casting / Bracing

• Traction / Suspension

• Early Motion




• Early Motion

Operative ManagementOperative Management

• Open Reduction

• Anatomical Restoration

• Internal Fixation

• Early Motion

• Open Reduction



• Early Motion

Mason HohlJBJS – 1967Mason HohlJBJS – 1967

Age Range :14 – 85 YearsAge Range :14 – 85 Years

Moore and HarveyJBJS – 1974


27 Acute Fractures3 Old Fractures

27 Acute Fractures3 Old Fractures

Elstrom and PankovichJBJS 1976

Elstrom and PankovichJBJS 1976

Soft Tissue Injuries6 Fractures

Soft Tissue Injuries6 Fractures

Associated Soft Tissue InjuriesAssociated Soft Tissue Injuries

• Ligaments

• Meniscus

• Articular Cartilage

• Ligaments

• Meniscus


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

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


• Aply

• Hohl, Et. Al.

• Martin

• Roberts

• Shelton

• Aply

• Hohl, Et. Al.

• Martin

• Roberts

• Shelton

ArthroscopyArthroscopy

• Low Risk Procedure

• Accurate Definition of Fx

• Soft Tissue Evaluation





• Reduction of Selected Fx

• Removal of Inter-articular Debris

• Post-healing Evaluation

• Reduction of Selected Fx

• Removal of Inter-articular Debris

• Post-healing Evaluation

Materials and MethodsMaterials and Methods

30 Fractures29 Patients


HospitalizationHospitalization

• Operative Group : 10 – 12 Days

• Non-operative Group : 27 Days (avg.)

• Operative Group : 10 – 12 Days

• Non-operative Group : 27 Days (avg.)

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 After Fracture Healing4 Cases

Arthroscopy After Fracture Healing4 Cases

Arthroscopy After Fracture Healing

Arthroscopy After Fracture Healing

• Mytosis Ossificans

• Loose Body

• Meniscectomy

• Abrasion Chondroplasty

• Mytosis Ossificans

• Loose Body

• Meniscectomy

• Abrasion Chondroplasty

1.Arthroscopy Is of Value in the Management of Tibial

Plateau Fractures.

1.Arthroscopy Is of Value in the Management of Tibial

Plateau Fractures.

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.

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)

Functional Range of Motion(10 – 100°)

Functional Range of Motion(10 – 100°)

• Non Operative Group 4.3 Mos.

• Arthrotomy Group 3.0 Mos.


• Non Operative Group 4.3 Mos.

• Arthrotomy Group 3.0 Mos.



Plateau Fractures


Plateau Fractures

Thank You !Thank You !

ComplicationsComplications

• Peroneal Nerve 3

• Delayed Union 1

• Suture Abscess 1

• Peroneal Nerve 3

• Delayed Union 1

• Suture Abscess 1

4. Healed, but Symptomatic Fractures May Benefit From

Arthroscopic Surgery

4. Healed, but Symptomatic Fractures May Benefit From

Arthroscopic Surgery

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.


Plateau Fractures


Plateau Fractures

30 Fractures1979 – 198430 Fractures1979 – 1984

Elstrom and PankovichJBJS – 1976

Elstrom and PankovichJBJS – 1976

Conservative ManagementConservative Management




• Early Motion




• Early Motion

Operative ManagementOperative Management

• Open Reduction



• Early Motion

• Open Reduction



• Early Motion

Mason HohlJBJS – 1967Mason HohlJBJS – 1967

Associated Soft Tissue InjuriesAssociated Soft Tissue Injuries

• Ligaments

• Meniscus


• Ligaments

• Meniscus


Materials and MethodsMaterials and Methods


• Aply

• Hohl, Et Al.

• Martin

• Roberts

• Shelton

• Aply

• Hohl, Et Al.

• Martin

• Roberts

• Shelton

ResultsResults

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

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

PatientsPatients

• Arthroscopic Surgery 17• Arthrotomy (Alone) 4• Arthroscopy and Arthrotomy 3

• Arthroscopic Surgery 17• Arthrotomy (Alone) 4• Arthroscopy and Arthrotomy 3

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

Arthroscopy and ArthrotomyArthroscopy and Arthrotomy

• ARIF / Meniscus Repair

• Arthroscopy / ORIF

• ORIF / Arthroscopy

• ARIF / Meniscus Repair

• Arthroscopy / ORIF

• ORIF / Arthroscopy

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

Surgery – 24 PatientsNo Surgery – 5 PatientsSurgery – 24 Patients

No Surgery – 5 Patients

arthroscopic treatment of tibial plateau fractures john f. meyers, m.d

Documents

arthroscopy group

mosarthrotomy group

daysnonoperative group

selected fractures

timely management decisions

symptomatic fractures

fracture healedpost

arthroscopic surgery3