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A sub-meniscal arthrotomy improves the medium-term patient outcome of tibial plateau fractures

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This trial was conducted to determine the medium-term functional outcome of displaced tibial plateau fracture patients treated with closed fluoroscopic assisted reduction and internal fixation (CRIF) versus patients treated with standard open reduction with sub-meniscal arthrotomy and internal fixation (ORIF).

Methods

A prospective trial was conducted in adult patients with displaced AO/OTA 41 B and 41 C tibial plateau fractures. Patients were assigned to treatment based upon the standard treatment of the surgeon involved following the call schedule for the day, either CRIF or ORIF. Postoperative radiographs and CT were performed on all patients and patients were followed for a minimum of 2 years. Primary outcome measures were the KOOS, SMFA and SF-36.

Results

Seventy patients were recruited with 2 year follow-up on 35 patients in the CRIF group and 27 patients in the ORIF group. Postoperative CT scans showed that reductions were better with the ORIF group especially in the posterolateral quadrant as compared to the CRIF group. The frequency of mal-reductions was higher in the CRIF group. The KOOS, at two years, showed that the CRIF had significantly less good outcomes in the subcategories of SPORT (p = 0.03) and QOL (p = 0.01) measurements.

Conclusions

ORIF with a sub-meniscal arthrotomy provides better quality reductions and better medium-term results as compared to CRIF for tibial plateau fractures. This may provide more long-term benefit from osteoarthritic symptoms in this patient group.

Level of evidence

Therapeutic, Level 2.

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Funding

This study was funded by the Orthopedic Research and Education Fund. The local University Ethics Board approval number was REB14-1953. This study was presented at the Orthopedic Trauma Association annual meeting in Vancouver, Canada October 14, 2017.

Author information

Authors and Affiliations

  1. 0490 McCaig Tower, 3134 Hospital Drive NW, Foothills Medical Center, University of Calgary, Calgary, AB, T2N 5A1, Canada

    Richard E. Buckley, Prism Schneider, Paul J. Duffy, Shannon Puloski, Robert Korley & C. Ryan Martin

  2. Suite 335 401-9th Ave SW, Calgary, AB T2P 3C5, Canada

    Robert Korley

Authors
  1. Richard E. Buckley
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  2. Prism Schneider
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  3. Paul J. Duffy
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  4. Shannon Puloski
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  5. Robert Korley
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  6. C. Ryan Martin
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Contributions

RB: Study design, Data collection, Writing the paper, Paper submission and revision. PS: Data analysis, Writing the paper, Paper submission and revision. PD: Study design, Data collection, Writing the paper, Paper submission and revision. SP: Study design, Data collection, Writing the paper, Paper submission and revision. RK: Study design, Data collection, Writing the paper, Paper submission and revision. CRM: Data analysis, Writing the paper, Paper submission and revision.

Corresponding author

Correspondence to Richard E. Buckley.

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Conflict of interest

Authors R. Buckley, P. Schneider, P. Duffy, S. Puloski, R. Korley, CR. Martin have no conflicts of interest to report.

Ethical approval

Ethical and research approval and consent was granted at the local conjoint University Ethics Board (#20818).

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Buckley, R.E., Schneider, P., Duffy, P.J. et al. A sub-meniscal arthrotomy improves the medium-term patient outcome of tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc 27, 837–844 (2019). https://doi.org/10.1007/s00167-018-5122-0

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  • DOI: https://doi.org/10.1007/s00167-018-5122-0

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