|
Year |
2002 |
|---|---|
|
Question Number |
59 |
|
Category |
Musculoskeletal Trauma |
Question
Which of the following factors has the greatest influence on achieving a good outcome following surgical treatment of tibial plateau fractures?
1- obtaining anatomic reduction of the articular surface
2- restoring mechanical alignment and stability
3- using minimally invasive stabilization techniques
4- initiating early knee range of motion
5- initiating early weight bearing
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Answer (click for answer)
Preferred response: 2.
Restoring mechanical alignment and stability has shown to be a more important factor in the outcome of tibial plateau fractures in comparison to the amount of anatomic reduction achieved. The first reference is a series of tibial plateau fractures, 102 of which were available for a mean follow-up of 20 years. 57 were treated surgically and 45 were treated conservatively. Outcome was measured by the patient’s pain level, ability to walk, their mobility and the stability of the knee. Their results were good to excellent in 90% of patients when clinical stability of the extended knee joint was the goal, irrespective of anatomic reduction. The second study shows that articular stepoff of 3mm and condylar widening up to 5mm are well tolerated subjectively and functionally. "Irregularities of the articular surface are well tolerated if the knee is well aligned and stable." This study also shows comparable results with prolonged immobilization and early motion of the knee.
Reference: 1) Lansinger O, Bergman B, Korner L, Andersson GD, Tibial condylar fractures: A twenty-year follow-up. J Bone Joint Surg Am 1986;68:13-19. 2) Honkonen SE: Indications for surgical treatment of tibial condyle fractures. Clin Orthop 1994;302:199-205.