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VOLUME 7 , ISSUE 3 ( November, 2012 ) > List of Articles

Original Article

Tibial plateau fractures: compared outcomes between ARIF and ORIF

C. Dall\'Oca, T. Maluta, F. Lavini, M. Bondi, G. M. Micheloni, P. Bartolozzi

Keywords : Tibial plateau fractures, ARIF, Arthroscopically assisted reduction, Post-traumatic arthrosis, External fixation

Citation Information : Dall\'Oca C, Maluta T, Lavini F, Bondi M, Micheloni GM, Bartolozzi P. Tibial plateau fractures: compared outcomes between ARIF and ORIF. 2012; 7 (3):163-175.

DOI: 10.1007/s11751-012-0148-1

License: CC BY-NC-SA 4.0

Published Online: 30-11-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


The purpose of this study is to compare arthroscopic assisted reduction internal fixation (ARIF) treatment with open reduction internal fixation (ORIF) treatment in patients with tibial plateau fractures. We studied 100 patients with tibial plateau fractures (54 men and 46 women) examined by X-rays and CT scans, divided into 2 groups. Group A with associated meniscus tear was treated by ARIF technique, while in group B ORIF technique was used. The follow-up period ranged from 12 to 116 months. The patients were evaluated both clinically and radiologically according to the Rasmussen and HSS (The Hospital for Special Surgery knee-rating) scores. In group A, the average Rasmussen clinical score is 27.62 ± 2.60 (range, 19–30), while in group B is 26.81 ± 2.65 (range, 21–30). HSS score in group A was 76.36 ± 14.19 (range, 38–91) as the average clinical result, while in group B was 73.12 ± 14.55 (range, 45–91). According to Rasmussen radiological results, the average score for group A was 16.56 ± 2.66 (range, 8–18), while in group B was 15.88 ± 2.71 (range, 10–18). Sixty-nine of 100 patients in our study had associated intra-articular lesions. We had 5 early complications and 36 late complications. The study suggests that there are no differences between ARIF and ORIF treatment in Schatzker type I fractures. ARIF technique may increase the clinical outcome in Schatzker type II–III–IV fractures. In Schatzker type V and VI fractures, ARIF and ORIF techniques have both poor medium- and long-term results but ARIF treatment, when indicated, is the best choice for the lower rate of infections.

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  1. Belanger M, Fadale P (1997) Compartment syndrome of the leg after arthroscopic examination of a tibial plateau fracture. Case report and review of the literature. Arthroscopy 13:646-651
  2. Bennett WF, Browner B (1994) Tibial plateau fractures: a study of associated soft tissue injuries. J Orthop Trauma 8:183-188
  3. Crist BD, Della Rocca GJ, Stannard JP (2010) Compartment syndrome surgical management techniques associated with tibial plateau fractures. J Knee Surg 23:3-7
  4. Dirschl DR, Dawson PA (2004) Injury severity assessment in tibial plateau fractures. Clin Orthop Relat Res 423:85-92
  5. Dirschl DR, Del Gaizo D (2007) Staged management of tibial plateau fractures. Am J Orthop (Belle Mead NJ) 36:12-17
  6. Duan XJ, Yang L, Guo L, Chan GX, Dai G (2008) Arthroscopically assisted treatment for Schatzker type I-V tibial plateau fractures. Chin J Traumatol 11(5):288-292
  7. Lachiewicz PF, Funcik T (1990) Factors influencing the results of open reduction and internal fixation of tibial plateau fractures. Clin Orthop Relat Res 259:210-215
  8. Rommens PM, Coosemans W, Broos PL (1989) The difficult healing of segmental fractures of the tibial shaft. Arch Orthop Trauma Surg 108:238-242
  9. Scheerlinck T, Ng CS, Handelberg F, Casteleyn PP (1998) Medium term results of percutaneous, arthroscopically-assisted osteosynthesis of fractures of the tibial plateau. J Bone Joint Surg Br 80:959-964
  10. Weinlein J, Schmidt A (2010) Acute compartment syndrome in tibial plateau fracture—beware! J Knee Surg 23:9-16
  11. Zhou Z (2009) Arthroscopic percutaneous osteosynthesis of low energy tibial plateau fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 23(11):1316-1318
  12. Biggi F, Di Fabio S, D'Antimo C, Trevisani S (2010) Tibial plateau fractures internal fixation with locking plates and the MIPO technique. Injury 41(11):1178-1182
  13. Farouk O, Krettek C, Miclau T et al (1997) Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury 28(1):A7-A12
  14. Musahl V, Tarkin I, Kobbe P et al (2009) New trends and techniques in open reduction and internal fixation of fractures of the tibial plateau. J Bone Joint Surg Br 91:426-433
  15. Ali AM, Saleh M, Bolongaro S, Yang L (2003) The strength of different fixation techniques for bicondylar tibial plateau fractures— a biomechanical study. Clin Biomech 18:864-870
  16. Ali AM, Saleh M, Eastell R, Wigderowitz CA, Rigby AS, Yang L (2006) Influence of bone quality on the strength of internal and external fixation of tibial plateau fractures. J Orthop Res 24:2080-2086
  17. Canadian Orthopaedic Trauma Society (2006) Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am 88:2613-2623
  18. Davies R, Holt N, Nayagam S (2005) The care of pin sites with external fixation. J Bone Joint Surg [Br] 87-B:716-719
  19. Giotakis N, Panchani SK, Narayan B, Larkin JJ, Al Maskari S, Nayagam S (2010) Segmental fractures of the tibia treated by circular external fixation. J Bone Joint Surg 92-B:687-692
  20. Mallik AR, Covall DJ, Whitelaw GP (1992) Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev 21:1433-1436
  21. Marsh JL, Smith ST, Do TT (1995) External fixation and limited internal fixation for complex fractures of the tibial plateau. J Bone Joint Surg Am 77:661-673
  22. Rademakers MV, Kerkhoffs GM, Sierevelt IN et al (2007) Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 21:5-10
  23. Young MJ, Barrack RL (1994) Complications of internal fixation of tibial plateau fractures. Orthop Rev 23:149-154
  24. Mui LW, Engelsohn E, Umans H (2007) Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury. Skeletal Radiol 36:145-151
  25. Te Stroet MA, Holla M, Biert J, Van Kampen A (2011) The value of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures. Emerg Radiol 18(4):279-283
  26. Buchko GM, Johnson DH (1996) Arthroscopically assisted operative management of tibial plateau fractures. Clin Orthop Rel Res 332:29-36
  27. Gill TJ, Moezzi DM, Oates KM, Sterett WI (2001) Arthroscopic reduction and internal fixation of tibial plateau fractures in skiing. Clin Orthop Rel Res 383:243-249
  28. Siegler J, Galissier B, Marcheix PS, Charissoux JL, Mabit C, Arnaud JP (2011) Percutaneous fixation of tibial plateau fractures under arthoscopy: a medium term perspective. Orthop Traumatol Surg Res 97:44-50
  29. Hsu CJ, Chang WN, Wong CY (2001) Surgical treatment of tibial plateau fracture in elderly patients. Arch Orthop Trauma Surg 121:67-70
  30. Lubokitz JH, Elson WS, Guttmann D (2004) Part I: arthroscopic management of tibial plateau fractures. Arthroscopy 20(12):1063-1070
  31. O'Dwyer KJ, Bobic VR (1992) Arthroscopic management of tibial plateau fractures. Injury 23:261-264
  32. Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res 138:94-104
  33. Oestern HJ, Tscherne H (1984) Pathophysiology and classification of soft tissue injuries associated with fractures. In: Tscherne H, Gotzen L (eds) Fractures with soft tissue injuries. Springer, Berlin
  34. Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ (2005) Staged management of high-energy proximal tibial fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma 19:448-455
  35. Tscherne H, Lobenhoffer P (1993) Tibial plateau fractures: management and expected results. Clin Orthop Relat Res 292:87-100
  36. Insall JN, Ranawat CS, Aglietti P, Shine J (1976) A comparison of four models of total knee replacement prostheses. J Bone Joint Surg [Am] 58-A:754-765
  37. Rasmussen PS (1973) Tibial condylar fractures. Impairment of knee joint function as an indication for surgical treatment. J Bone Joint Surg Am 55:1331-1350
  38. Chan Y-S, Chiu C-H, Lo Y-P, Chen AC-Y, Hsu K-Y, Wang C-J, Chen W-J (2008) Arthroscopy-assisted surgery for tibial plateau fractures: 2- to 10-year follow-up results. Arthroscopy 24:760-768
  39. Chan Y-S, Yuan L-J, Hung S-S, Wang C-J, Shang-Won Y, Chen C-Y, Chao E-K, Lee M (2003) Arthroscopic-assisted reduction with bilateral buttress plate fixation of complex tibial plateau fractures. Arthroscopy 19:974-984
  40. Cassard X, Beaufils P, Blin JL, Hardy P (1999) Osteosynthesis under arthroscopic control of separated tibial plateau fractures. 26 case reports. Rev Chir Orthop 85:257-266
  41. Stamer DT, Schenk R, Staggers B, Aurori K, Aurori B, Behrens FF (1994) Bicondylar tibial plateau fractures treated with a hybrid ring external fixator: a preliminary study. J Orthop Trauma 8:455-461
  42. Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK (2004) Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 18:649-657
  43. Mohamed Zaki A-H, Chung-Hsun C, Yi-Sheng C, Yang-Pin L, Jau-Wen H, Kuo-Yao H, Ching-Jen W (2006) Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases. Arthroscopy 22:669-675
  44. Holt MD, Williams LA, Dent CM (1995) MRI in the management of tibial plateau fractures. Injury 26:595-599
  45. Chan YS, Yuan LJ, Hung SS et al (2003) Arthroscopicallyassisted reduction with bilateral buttress plate fixation of complex tibial plateau fractures. Arthroscopy 19:974-984
  46. Hung SS, Chao EK, Chan YS et al (2003) Arthroscopicallyassisted osteosynthesis for tibial plateau fractures. J Trauma 54:356-363
  47. Giannoudis PV, Tzioupis C, Papathanassopoulos A, Obakponovwe O, Roberts C (2010) Articular step-off and risk of post-traumatic osteoarthritis. Evidence today. Injury Int J Care Injured 41:986-995
  48. Marsh JL, Buckwalter J, Gelberman R et al (2002) Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am 84-A:1259-1271
  49. Honkonen SE (1995) Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 9:273-277
  50. Moore TM, Patzakis MJ, Harvey JP (1987) Tibial plateau fractures: definition, demographics, treatment rationale, and longterm results of closed traction management or operative reduction. J Orthop Trauma 1:97-119
  51. Woll TS, Duwelius PJ (1992) The segmental tibial fracture. Clin Orthop 281:204-207
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