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Management and incidence of tibial tubercle fractures in bicondylar fractures of the tibial plateau

http://www.bjj.boneandjoint.org.uk/content/95-B/12/1697.abstract

Management and incidence of tibial tubercle fractures in bicondylar fractures of the tibial plateau

  1. M. D. Maroto, MD, Assistant Professor1;
  2. M. B. Henley, MD, Professor2; and
  3. R. P. Dunbar, MD, Associate Professor2
+ Author Affiliations
  1. 1University of Texas, Southwestern Medical Center, 5325 Harry Hines Blvd, Dallas, Texas 75390, USA.
  2. 2Harborview Medical Center, Department of Orthopaedics and Sports Medicine, University of Washington, 325 9th Avenue, Seattle, Washington 98104, USA.
  1. Correspondence should be sent to Dr R. P. Dunbar; e-mail: dunbar@uw.edu

Abstract

Fracturas de meseta tibial bicondilar el resultado de lesiones de alta energía. Las fracturas de la meseta tibial pueden implicar el tubérculo tibial , lo que representa una interrupción en el mecanismo extensor y, lógicamente, debe ser estabilizado . El propósito de este estudio fue identificar la incidencia de una fractura del tubérculo tibial independiente en las fracturas de meseta tibial bicondilares , e informar las estrategias de manejo y complicaciones potenciales. Revisamos retrospectivamente una base de datos de trauma ortopédico recogido de forma prospectiva para el período enero 2003 a diciembre 2008 , y se identificaron 392 fracturas bicondilares de la meseta tibial , en la que se identificaron 85 fracturas del tubérculo tibial (21,6%) en 84 pacientes. Había 60 hombres y 24 mujeres en nuestro grupo de estudio, con una edad media de 45,4 años (18 a 71). En 84 fracturas se realizó reducción abierta y fijación interna , ya sea con tornillos solos ( 23 pacientes) o con una placa y tornillos ( 61 pacientes). El paciente restante se trató de forma conservadora . En total, 52 fracturas estaban disponibles para la evaluación clínica y radiológica en una media de seguimiento de 58,5 semanas ( 24-94 ) . Todas las fracturas de la tuberosidad tibial unidos , pero 24 de 54 fracturas ( 46 %) requirieron un procedimiento secundario para su fractura de meseta tibial . Cuatro pacientes reportaron dolor que surge de placas y tornillos de tubérculos prominentes, que en un caso así proceda . Fracturas del tubérculo tibial se produjeron en más de una quinta parte de las fracturas de la meseta tibial bicondilares en nuestra serie. La fijación es necesaria y se puede realizar de forma fiable con tornillos solos o con un tornillo y la placa , que restaura el mecanismo extensor y facilita la flexión de la rodilla temprano.

Bicondylar tibial plateau fractures result from high-energy injuries. Fractures of the tibial plateau can involve the tibial tubercle, which represents a disruption to the extensor mechanism and logically must be stabilised. The purpose of this study was to identify the incidence of an independent tibial tubercle fracture in bicondylar tibial plateau fractures, and to report management strategies and potential complications. We retrospectively reviewed a prospectively collected orthopaedic trauma database for the period January 2003 to December 2008, and identified 392 bicondylar fractures of the tibial plateau, in which 85 tibial tubercle fractures (21.6%) were identified in 84 patients. There were 60 men and 24 women in our study group, with a mean age of 45.4 years (18 to 71). In 84 fractures open reduction and internal fixation was undertaken, either with screws alone (23 patients) or with a plate and screws (61 patients). The remaining patient was treated non-operatively. In all, 52 fractures were available for clinical and radiological assessment at a mean follow-up of 58.5 weeks (24 to 94). All fractures of the tibial tubercle united, but 24 of 54 fractures (46%) required a secondary procedure for their tibial plateau fracture. Four patients reported pain arising from prominent tubercle plates and screws, which in one patient required removal. Tibial tubercle fractures occurred in over one-fifth of the bicondylar tibial plateau fractures in our series. Fixation is necessary and can be reliably performed with screws alone or with a screw and plate, which restores the extensor mechanism and facilitates early knee flexion.
Cite this article: Bone Joint J 2013;95-B:1697–1702.

Footnotes

  • No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
    This article was primary edited by G. Scott and first-proof edited by D. Rowley.
  • Received March 24, 2013.
  • Accepted August 1, 2013.
  • ©2013 The British Editorial Society of Bone & Joint Surgery

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