The purpose of this study is twofold: (1) to describe the indications for arthroscopic assisted fixation of lateral tibial plateau fractures based on the “cortical envelope”; and(2) to present the mid to long term outcomes of patients treated with arthroscopic assisted fixation and bone grafting from a medial metaphyseal window.
A retrospective review of a selected case series performed by a single surgeon of Schatzker Type II tibial plateau fractures treated with arthroscopic assisted reduction and percutaneous fixation was performed. All patients were followed using Rasmussen’s criteria for clinical and radiographic assessment.
Sixteen patients (9 females, 7 males) were included in this study, with an average age of 44.8 years (range 32 to 78 years). Mean clinical and radiographic follow-up was 28 months (range 8 to 93 months). All patients achieved good-excellent results with mean clinical and radiographic Rasmussen scores of 29.5 and 17.5 respectively. At final follow-up average knee flexion was 141 degrees (range 125 to 150). All but one patient achieved full extension. Most common complication was painful hardware requiring removal in five patients. Three patients had minimal loss of reduction (2 to 4 mm), and only one patient developed post traumatic osteoarthrosis, clinically asymptomatic at two-year follow-up.
Arthroscopic-assisted fixation and percutaneous pinning for lateral tibial plateau fractures utilizing the “Medial Approach” is an excellent treatment modality in carefully selected patients and fracture types. Understanding the concept of the “cortical envelope” will help guide the surgeon in selecting fracture patterns amenable to the technique.
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.