Of these four, three were treated with ORIF and one with conservative treatment. 8 Low-energy Schatzker class I and II constituted 3.2% (1) and 9.7% (3) of nonunions in this study, respectively. 15 In the presence of high-energy tibial fractures, physicians should be cognizant of fracture patterns contributing towards nonunion.Īlthough previous research attributed low-energy nonunion to missed diagnosis or benign neglect, our findings seem to indicate otherwise. 15 In addition, 77% of patients experienced at least one tear or avulsion of the collateral or cruciate ligaments. 14 In a radiographic study of 103 tibial plateau fractures, 91% of patients had a lateral meniscal injury and 44% had a medial meniscal injury. Additionally, adjacent structures such as the meniscus and other soft tissues have the potential to displace into the fracture site, preventing adequate bony apposition, resulting in nonunion as evidenced by Toro-Arbelaez et al. This is not an unexpected finding, as high-energy Schatzker class VI fractures at the metaphyseal-diaphyseal junction result in compromised blood supply and associated soft tissue injury. The majority of nonunions in this study were associated with high energy trauma (52.2%) and were Schatzker class VI (54.8%). This study presents the first review of the literature analyzing characteristics and outcomes of tibial plateau nonunions. Accordingly, the authors review the available literature on tibial plateau nonunions to quantify and report patient and fracture traits, possible risk factors, and treatment outcomes. 11, 12 To our knowledge, no systematic reviews on tibial plateau nonunions exist to date. Of the studies that do exist, some do not include important nonunion characteristics and others do not differentiate nonunions from malunions when presenting data. 3, 9, 10 Despite the need to improve our understanding of tibial plateau nonunions, a paucity of research persists. Just as etiology and fracture behavior differ for lateral, medial, and posteromedial tibial plateau fractures, their respective nonunions may also carry their own set of unique characteristics that have not been identified or described. 1, 7 In cases of low-energy trauma, simple fracture patterns may seem amendable to conservative management, but displacement of fracture fragments could lead to nonunion. 1, 7 As a result, risk of nonunion is elevated in high energy trauma and has been reported to be as high as 10–20%. However, high-energy fractures (Schatzker V and VI) are associated with significant vascular compromise and soft tissue injury. 6 A robust blood supply to the proximal tibia facilitates osteogenic processes and reduce the risk of nonunion. Tibial plateau nonunions are rare and represent just 1–2% of tibial plateau fracture complications. 4, 5 The remaining portion of complications is composed of less frequent complications such as nonunion, implant failure, and symptomatic implant. 1, 2, 3 Malunions or residual deformity make up another significant portion of the complications with rates up to 10%. 1 As a result, complication rates for high-energy tibial plateau fractures treated surgically have been reported up to 30%, with infection and wound complications constituting the majority. While low-energy falls typically lead to simple fracture patterns, high-energy trauma results in more complex fractures that are associated soft tissue injury, compartment syndrome, neurologic compromise, or infection. Tibial plateau fractures are challenging injuries associated with significant morbidity and risk for poor outcome. Subsequently, a bimodal distribution exists between high-energy accidents in younger adults and low-energy falls in the elderly. These periarticular fractures occur when axial loading is combined with varus or valgus stress on the knee. Tibial plateau fractures represent 1% of all fractures and remain a difficult surgical and clinical problem despite recent surgical advancements.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |