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The findings of intra-articular injuries and the early complications in using arthroscopy-assisted surgery for tibial plateau fractures

摘要


Background: Arthroscopic reduction and internal fixation (ARIF) for tibial plateau fracture has been reported to provide direct visualization of intra-articular fragments, achieve accurate fracture reduction, and yield less soft tissue stripping. However, the incidence of postoperative complications in patients treated with ARIF remains unclear. Purpose: We conducted a series study of patients with tibial plateau fracture receiving ARIF, evaluated their intra-articular injuries, and followed up their postoperative conditions, with a focus on the management of those injuries. Methods: We retrospectively analyzed patients with closed tibial plateau fracture receiving ARIF in our medical center between 1997 and 2015. These patients were treated with arthroscopically assisted reduction and osteosynthesis, and with precise diagnosis and management of associated intra-articular injuries. The arthroscopic findings for the intra-articular injuries were recorded, as well as the postoperative complications such as superficial and deep infections, compartment syndrome, and neurovascular injuries. Results: There were 202 enrolled patients with closed tibial plateau fractures receiving ARIF, including 4 (2%), 80 (40%), 6 (3%), 25 (12%), 32 (16%) and 55 (27%) patients with Schatzker type I-VI, respectively. Anterior cruciate ligament avulsion fracture and lateral meniscus tear were the most commonly encountered intra-articular injuries, and higher incidence of intra-articular injuries occurred in highenergy pattern tibial plateau fractures (p = 0.016). Six patients (3%) suffered from postoperative complications, including four cases of deep infections, and 67% of these complications occurred in patients with Schatzker type VI. No compartment syndrome or neurovascular injury was noted in our series. Conclusion: A variety of intra-articular injuries are common in tibial plateau fractures and can be precisely diagnosed with the use of an arthroscope. ARIF of tibial plateau fractures has the advantages of identifying and treating fractures and concomitant intra-articular lesions in a one-stage surgery. It also provides a lower postoperative complication rate.

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