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Immediate Knee Joint Range of Motion after Stable Fixation of Tibial Plateau Fractures

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DOI: 10.4236/ojo.2015.57027    2,830 Downloads   3,218 Views   Citations

ABSTRACT

The purpose of this study was to evaluate factors that affect initiation of early postoperative range of motion (ROM) rehabilitation and to investigate whether the postoperative ROM and clinical outcomes were affected by initiation of early ROM, immobilization and other factors. We conducted a retrospective analysis of tibial plateau fractures treated using stable internal fixation between December 2003 and June 2007. The resulting degree of flexion and Rasmussen Clinical and Radiographic Scores were evaluated. Thirty-nine patients were included, and 23 patients underwent a lateral submeniscal arthrotomy for evaluation of joint surface reduction, with 6 lateral meniscus lesions identified via arthrotomy. Three lateral collateral ligament lesions, 3 medial collateral ligament lesions and 1 anterior cruciate ligament lesion were found. Meniscus and ligament lesions significantly and negatively affected the initiation of knee joint ROM. Early ROM was achieved in 26 cases and 13 patients underwent immobilization for 4 weeks. At the final evaluation, the early ROM group had 130.42° ± 5.50° of flexion, compared with 122.92° ± 5.28° in the immobilization group. Moreover, the final Rasmussen score was 25.69 ± 2.92 in the early motion group, compared with 22.61 ± 3.5 in the immobilization group. There was no difference between radiographic scores of the groups. Although the initiation of early ROM improved the clinical results, soft tissue lesions influenced initiation of early knee joint motion. Therefore, meniscus and ligament injuries should be considered as prognostic factors in similar cases.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Arslan, A. , Polat, M. , Ciliz, A. and Utkan, A. (2015) Immediate Knee Joint Range of Motion after Stable Fixation of Tibial Plateau Fractures. Open Journal of Orthopedics, 5, 198-207. doi: 10.4236/ojo.2015.57027.

References

[1] Timmers, T.K., van der Ven, D.J., de Vries, L.S. and van Olden, G.D. (2014) Functional Outcome after Tibial Plateau Fracture Osteosynthesis: A Mean Follow-Up of 6 Years. The Knee, 21, 1210-1215.
http://dx.doi.org/10.1016/j.knee.2014.09.011
[2] Russell, N., Tamblyn, P. and Jaarsma, R. (2009) Tibial Plateau Fractures Treated with Plate Fixation: To Lock or Not to Lock. European Journal of Orthopaedic Surgery & Traumatology, 19, 75-82.
http://dx.doi.org/10.1007/s00590-008-0372-z
[3] Babis, G.C., Evangelopoulos, D.S., Kontovazenitis, P., Nikolopoulos, K. and Soucacos, P.N. (2011) High Energytibial Plateau Fractures Treated with Hybrid External Fixation. Journal of Orthopaedic Surgery and Research, 6, 35.
http://dx.doi.org/10.1186/1749-799X-6-35
[4] Markhardt, B.K., Gross, J.M. and Monu, J.U. (2009) Schatzker Classification of Tibial Plateau Fractures: Use of CT and MR Imaging Improves Assessment. RadioGraphics, 29, 585-597.
http://dx.doi.org/10.1148/rg.292085078
[5] Guanche, C.A. and Markman, A.W. (1993) Artroscopic Management of Tibial Plateau Fractures. Arthroscopy, 9, 467-471.
http://dx.doi.org/10.1016/S0749-8063(05)80324-X
[6] Vangsness Jr., C.T., Ghaderi, B., Hohl, M. and Moore, T.M. (1994) Arthroscopy of Meniscal Injuries with Tibial Plateau Fractures. Journal of Bone and Joint Surgery, 76, 488-490.
http://www.ncbi.nlm.nih.gov/pubmed/8175862
[7] Forman, J.M., Karia, R.J., Davidovitch, R.I. and Egol, K.A. (2013) Tibial Plateau Fractures with and without Meniscus Tear Results of a Standardized Treatment Protocol. Bulletin of the Hospital for Joint Diseases, 71, 144-151.
http://www.ncbi.nlm.nih.gov/pubmed/24032616
[8] Agnew, S.G. (1999) Tibial Plateau Fractures. Operative Techniques in Orthopaedics, 9, 197-205.
http://dx.doi.org/10.1016/S1048-6666(99)80018-4
[9] Rademakers, M.V., Kerkhoffs, G.M., Sierevelt, I.N., Raaymakers, E.L. and Marti, R.K. (2007) Operative Treatment of 109 Tibial Plateau Fractures: 5- to 27-Year Follow-Up Results. Journal of Orthopaedic Trauma, 21, 5-10.
http://dx.doi.org/10.1097/BOT.0b013e31802c5b51
[10] Mitchell, N. and Shepard, N. (1976) The Resurfacing of Adult Rabbit Articular Cartilage by Multiple Perforations through the Subchondral Bone. Journal of Bone and Joint Surgery, 58, 230-233.
http://www.ncbi.nlm.nih.gov/pubmed/56336
[11] Manidakis, N., Dosani, A., Dimitriou, R., Stengel, D., Matthews, S. and Giannoudis, P. (2010) Tibialplateau Fractures: Functional Outcome and Incidence of Osteoarthritis in 125 Cases. International Orthopaedics, 34, 565-570.
http://dx.doi.org/10.1007/s00264-009-0790-5
[12] Schatzker, J., McBroom, R. and Bruce, D. (1979) The Tibial Plateau Fracture. The Toronto Experience 1968-1975. Clinical Orthopaedics and Related Research, 138, 94-104.
http://www.ncbi.nlm.nih.gov/pubmed/445923
[13] Raza, H., Hashmi, P., Abbas, K., Hafeez, K. (2012) Minimally Invasive Plate Osteosynthesis for Tibial Plateau Fractures. Journal of Orthopaedic Surgery (Hong Kong), 20, 42-47.
http://www.ncbi.nlm.nih.gov/pubmed/22535810
[14] Volpin, G., Dowd, G.S., Stein, H. and Bentley, G. (1990) Degenerative Arthritis after Intraarticular Fractures of the Knee. Long-Term Results. Journal of Bone and Joint Surgery, 72, 634-638.
http://www.ncbi.nlm.nih.gov/pubmed/2380219
[15] Rasmussen, P.S. (1973) Tibial Condylar Fractures. Impairment of Knee Joint Stability as an Indication for Surgical Treatment. Journal of Bone and Joint Surgery, 55, 1331-1350.
http://www.ncbi.nlm.nih.gov/pubmed/4586086
[16] Burdin, G. (2013) Arthroscopic Management of Tibial Plateau Fractures: Surgical Technique. Orthopaedics & Traumatology-Surgery & Research, 99, S208-S218.
http://dx.doi.org/10.1016/j.otsr.2012.11.011
[17] Bennett, W.F. and Browner, B. (1994) Tibial Plateau Fractures: A Study of Associated Soft Tissue Injuries. Journal of Orthopaedic Trauma, 8, 183-188.
http://dx.doi.org/10.1097/00005131-199406000-00001
[18] Appley, A.A. (1979) Fractures of the Tibial Plateau. Clinical Orthopeadics and Related Research, 10, 61-74.
[19] Honkonen, S.E. (1994) Indications for Surgical Treatment of Tibial Condyle Fractures. Clinical Orthopaedics and Related Research, 302, 199-205.
http://dx.doi.org/10.1097/00003086-199405000-00031
[20] Watson, J.T. (1994) High-Energy Fractures of the Tibial Plateau. Orthopedic Clinics of North America, 25, 723-752.
http://www.ncbi.nlm.nih.gov/pubmed/8090483
[21] Vyrkus, W.W. and Helfet, D.L. (2001) Tibial Plateau Fractures. In: Insall, J.N. and Scott, W.N., Eds., Surgery of the Knee, Vol. 2, 3rd Edition, Churchill Livingston, Philadelphia, 1265-1289.
[22] Kohut, M. and Leyvraz, P.F. (1994) Cartilaginous, Meniscal and Ligamentous Lesions in the Prognosis of Tibial Plateau Fractures. Acta Orthopaedica Belgica, 60, 81-88.
[23] Blokker, C.P., Rorabeck, C.H. and Bourne, R.B. (1984) Tibial Plateau Fractures. An Analysis of Treatment in 60 Patients. Clinical Orthopaedics and Related Research, 182, 193-198.
http://dx.doi.org/10.1097/00003086-198401000-00025
[24] Hohl, M. (1991) Fractures of the Proximal Tibial and Fibula. In: Rockwood, C.A., Green, D.P. and Bucholz, R.W., Eds., Fracture in Adults, Chap. 20, Part I, J.P. Lippincott Co., Philadelphia, 1725-1752.
[25] Holt, M.D., Williams, L.A. and Dent, C.M. (1995) MRI in the Management of Tibial Plateau Fractures. Injury, 26, 595-599.
http://dx.doi.org/10.1016/0020-1383(95)00109-M
[26] Gardner, M.J., Yacoubian, S., Geller, D., Suk, M., Mintz, D., Potter, H., et al. (2005) The Incidence of Soft Tissue Injury in Operative Tibial Plateau Fractures: A Magnetic Resonance Imaging Analysis of 103 Patients. Journal of Orthopaedic Trauma, 19, 79-84.
http://dx.doi.org/10.1097/00005131-200502000-00002
[27] Caspari, R.B., Hutton, P.M., Whipple, T.L. and Meyers, J.F. (1985) The Role of Arthroscopy in the Management of Tibial Plateau Fractures. Arthroscopy, 1, 76-82.
http://dx.doi.org/10.1016/S0749-8063(85)80035-9
[28] Roberts, J.M. (1968) Fractures of the Condyles of the Tibia. An Anatomical and Clinical End-Result Study of One Hundred Cases. Journal of Bone and Joint Surgery, 50, 1505-1521.
http://www.ncbi.nlm.nih.gov/pubmed/5722847
[29] Watson, J.T. and Wiss, D.A. (2001) Fractures of Proximal Tibia and Fibula. In: Rockwood, C., Green, D. and Bucholz, R., Eds., Fractures in Adults, 5th Edition, Lippincott Williams-Wilkins Company, Philadelphia, 1801-1806.
[30] Watson, J.T. and Schatzker, J. (1998) Tibial Plateau Fractures. In: Browner, B.D., Levine, A.M., Jupiter, J.B. and Trafton, P.G., Eds., Skeletal Trauma, Vol. 2, 2nd Edition, W.B. Saunders, Philadelphia, 2143-2186.
[31] Hohl, M. (1995) Complication of Tibial Plateau Fractures. In: Epps, C.H., Ed., Complication in Orthopaedic Surgery, Chap. 20.3, 3rd Edition, J.B. Lippincott Co., Philadelphia, 540-552.
[32] Moore, T.M., Patzakis, M.J. and Harvey, J.P. (1987) Tibial Plateau Fractures: Definition, Demographics, Treatment Rationale, and Long-Term Results of Closed Traction Management or Operative Reduction. Journal of Orthopaedic Trauma, 1, 97-119.
http://dx.doi.org/10.1097/00005131-198702010-00001
[33] Kuzgun, U., Ozturk, I. and Ordueri, M. (1991) The Results of Conservative and Surgical Treatment of Tibial Plateau Fractures. Acta Orthopaedica et Traumatologica Turcica, 25, 391-393.
http://www.aott.org.tr/article/viewFile/5000008694/5000008484

  
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