Can tibial plateau fractures be reduced and stabilised through an angiosome-sparing antero-lateral approach?

Lucian B Solomon; P R J V C Boopalan; Adhiraj Chakrabarty; Stuart A Callary

doi:10.1016/j.injury.2013.11.035

Can tibial plateau fractures be reduced and stabilised through an angiosome-sparing antero-lateral approach?

Injury. 2014 Apr;45(4):766-74. doi: 10.1016/j.injury.2013.11.035. Epub 2013 Dec 10.

Authors

Lucian B Solomon¹, P R J V C Boopalan², Adhiraj Chakrabarty³, Stuart A Callary⁴

Affiliations

¹ Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia. Electronic address: bogdansolomon@mac.com.
² Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Christian Medical College, Vellore 632004, Tamil Nadu, India.
³ Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
⁴ Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.

PMID: 24380535
DOI: 10.1016/j.injury.2013.11.035

Abstract

Introduction and aim: Tibial plateau fractures (TPFs) are an independent, non-modifiable risk factor for surgical site infections (SSIs). Current antero-lateral approaches to the knee dissect through the anterior tibial angiosome (ATA), which may contribute to a higher rate of SSIs. The aim of this study was to develop an angiosome-sparing antero-lateral approach to allow reduction and fixation of lateral TPFs and to investigate its feasibility in a consecutive cohort.

Methods: Twenty cadaveric knees were dissected to define the position of the vessels supplying the ATA from the lateral tibial condyle to the skin perforators. Based on these results, an angiosome-sparing surgical approach to treat lateral TPFs was developed. Fifteen consecutive patients were subsequently treated through this approach. Clinical outcomes included assessment of SSI and Lysholm score. Fracture healing and stability were assessed using the Rasmussen score and radiostereometric analysis (RSA).

Results: At the latest follow-up between 1 and 4 years, there was no report of SSI. Nine patients (60%) had good or excellent Lysholm scores. The mean Rasmussen score at final follow-up was 17 (median 18, range 14-18) with 10 patients (66%) graded as excellent. Fracture fragment migration measured using RSA was below 2mm in all cases.

Discussion: This study has demonstrated that an angiosome-sparing antero-lateral approach to the lateral tibial plateau is feasible. Adequate stability of these fracture types was achieved by positioning a buttress plate away from the bone and superficial to the regional fascial layer as an 'internal-external fixator'.

Conclusion: The angiosome-sparing approach developed was able to be used in a prospective cohort and the clinical results to date are encouraging. Future clinical studies need to investigate the potential benefits of this surgical approach when compared with the previously described antero-lateral approaches.

Keywords: Angiosome; Internal fixation; RSA; Surgical site infection; Tibial plateau fracture.

Publication types

Evaluation Study

MeSH terms

Adult
Bone Plates*
Cadaver
Feasibility Studies
Female
Fracture Fixation, Internal*
Fracture Healing
Humans
Knee Joint / blood supply*
Knee Joint / physiopathology
Knee Joint / surgery*
Male
Middle Aged
Prospective Studies
Range of Motion, Articular
Recovery of Function
Regional Blood Flow
Surgical Wound Infection / prevention & control*
Tibial Fractures / physiopathology
Tibial Fractures / surgery*
Time Factors
Treatment Outcome
Weight-Bearing