"Fracturoscopy" is Superior to Fluoroscopy in the Articular Reconstruction of Complex Tibial Plateau Fractures-An Arthroscopy Assisted Fracture Reduction Technique
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"Fracturoscopy" is Superior to Fluoroscopy in the Articular Reconstruction of Complex Tibial Plateau Fractures-An Arthroscopy Assisted Fracture Reduction Technique. / Krause, Matthias; Preiss, Achim; Meenen, Norbert M; Madert, Jürgen; Frosch, Karl-Heinz.
in: J ORTHOP TRAUMA, Jahrgang 30, Nr. 8, 08.2016, S. 437-44.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - "Fracturoscopy" is Superior to Fluoroscopy in the Articular Reconstruction of Complex Tibial Plateau Fractures-An Arthroscopy Assisted Fracture Reduction Technique
AU - Krause, Matthias
AU - Preiss, Achim
AU - Meenen, Norbert M
AU - Madert, Jürgen
AU - Frosch, Karl-Heinz
PY - 2016/8
Y1 - 2016/8
N2 - OBJECTIVE: To analyze the anatomic accuracy of fracture reduction controlled by fluoroscopy as compared with arthroscopically assisted reduction ("fracturoscopy") in patients with complex tibial plateau fractures (AO/OTA 41-C). Quality of fracturoscopy-guided reduction was checked with postoperative computed tomography.DESIGN: Prospective observational study.SETTING: Urban level 1 trauma center.PATIENTS: Seventeen consecutive patients, with a complex, bicondylar tibial plateau fracture.INTERVENTION: The intraoperative, open insertion of an arthroscope (2.4-mm or 2.8-mm optics), to visualize the articular surface and fracture reduction.MAIN OUTCOME MEASUREMENTS: Ability to detect residual fracture depression or gap after previous open reduction under fluoroscopic guidance.RESULTS: An open fracture reduction with fluoroscopic guidance was performed in all cases. In 7 cases, open reduction and fluoroscopy resulted in satisfactory fracture reduction (fluoroscopy group). In 10 of 17 cases, subsequent "fracturoscopy" showed persistent fracture depression (≥2 mm, fracturoscopy group) with the need for intraoperative correction. Patients in the fracturoscopy group demonstrated significantly greater preoperative fragment depression (12.55 ± 6.56 mm) and a larger preoperative fracture gap (7.83 ± 5.49 mm) compared with patients with a satisfactory reduction under fluoroscopy (depression 4.97 ± 4.02 mm, P = 0.016; gap 2.47 ± 1.07 mm, P = 0.023). Fluoroscopy was not successful in achieving satisfactory reduction in cases in which the postero-latero-central region was affected (P = 0.004, χ test). Postoperative computed tomography demonstrated satisfactory articular reconstruction in all cases.CONCLUSIONS: Intraoperative fracturoscopy permitted a significantly improved visualization of fracture fragment displacement, specifically in the postero-latero-central region of the tibial plateau, as compared with fluoroscopy. Fracturoscopy is recommended for fractures involving the postero-latero-central region of the tibial plateau.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
AB - OBJECTIVE: To analyze the anatomic accuracy of fracture reduction controlled by fluoroscopy as compared with arthroscopically assisted reduction ("fracturoscopy") in patients with complex tibial plateau fractures (AO/OTA 41-C). Quality of fracturoscopy-guided reduction was checked with postoperative computed tomography.DESIGN: Prospective observational study.SETTING: Urban level 1 trauma center.PATIENTS: Seventeen consecutive patients, with a complex, bicondylar tibial plateau fracture.INTERVENTION: The intraoperative, open insertion of an arthroscope (2.4-mm or 2.8-mm optics), to visualize the articular surface and fracture reduction.MAIN OUTCOME MEASUREMENTS: Ability to detect residual fracture depression or gap after previous open reduction under fluoroscopic guidance.RESULTS: An open fracture reduction with fluoroscopic guidance was performed in all cases. In 7 cases, open reduction and fluoroscopy resulted in satisfactory fracture reduction (fluoroscopy group). In 10 of 17 cases, subsequent "fracturoscopy" showed persistent fracture depression (≥2 mm, fracturoscopy group) with the need for intraoperative correction. Patients in the fracturoscopy group demonstrated significantly greater preoperative fragment depression (12.55 ± 6.56 mm) and a larger preoperative fracture gap (7.83 ± 5.49 mm) compared with patients with a satisfactory reduction under fluoroscopy (depression 4.97 ± 4.02 mm, P = 0.016; gap 2.47 ± 1.07 mm, P = 0.023). Fluoroscopy was not successful in achieving satisfactory reduction in cases in which the postero-latero-central region was affected (P = 0.004, χ test). Postoperative computed tomography demonstrated satisfactory articular reconstruction in all cases.CONCLUSIONS: Intraoperative fracturoscopy permitted a significantly improved visualization of fracture fragment displacement, specifically in the postero-latero-central region of the tibial plateau, as compared with fluoroscopy. Fracturoscopy is recommended for fractures involving the postero-latero-central region of the tibial plateau.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
KW - Arthroscopy
KW - Female
KW - Fluoroscopy
KW - Fracture Fixation
KW - Humans
KW - Knee Injuries
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Reproducibility of Results
KW - Sensitivity and Specificity
KW - Surgery, Computer-Assisted
KW - Tibial Fractures
KW - Treatment Outcome
KW - Comparative Study
KW - Journal Article
KW - Observational Study
U2 - 10.1097/BOT.0000000000000569
DO - 10.1097/BOT.0000000000000569
M3 - SCORING: Journal article
C2 - 26978133
VL - 30
SP - 437
EP - 444
JO - J ORTHOP TRAUMA
JF - J ORTHOP TRAUMA
SN - 0890-5339
IS - 8
ER -
