2015 ISAKOS Biennial Congress ePoster #601

Arthroscopic Assistance in Tibial Plateau Fractures Schatzker V-VI. Are There Anymore Complications?

Carlos Rojas, MD, Santiago, Region Metropolitana CHILE
Alvaro Valenzuela, MD, Viña Del Mar CHILE
Javier Ignacio Lecaros Bahamondes, MD, Santiago CHILE
Piero Innocenti, MD, Santiago CHILE
Nicolas Gaggero, MD, Santiago, La reina CHILE
Maximiliano Vega, MD, Santiago CHILE
Roberto Abusleme, MD, Santiago, Providencia CHILE
Angello Canales, MD, Santiago CHILE
Carlos Sandoval, MD, Providencia, Región Metropolitana CHILE

Hospital del Trabajador, Santiago, Region Metropolitana, CHILE

FDA Status Not Applicable

Summary: We compare the incidence of compartment syndrome and other complications in Tibial Plateau Fractures Schatzker V-VI, between patients who were treated with or without Arthroscopically Assisted Reduction and Internal Fixation. We haven’t found significant differences in the two groups. The use of this technique, as a diagnostic and therapeutic tool in these patients, seems like a safe alternative.

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Abstract:

Arthroscopic assistance in Tibial Plateau Fractures Schatzker V-VI. Are there anymore complications?

Objective

Compare compartment syndrome and others complications, after arthroscopic assistance previous open reduction and internal fixation(AORIF), with open reduction and internal fixation (ORIF) in patients with tibial plateau fractures (TPF) Schatzker V and VI.

Materials And Methods

The patients admitted were those with TPF Schatzker V-VI diagnosis, between September 2007 and December 2013. Patients that received treatments previously in other health facilities and those who required the use of external fixation for soft tissue involvement and open fractures were excluded.
They were divided into two groups: operative treatment by ORIF or AORIF. The demographic data was analyzed, the time of surgical treatment, complications and outcome of reduction with computerized tomography (CT). Anatomic reduction was considered as a gap with less than 2 mm. The reduction was satisfactory between 2 and 4 mm, and insufficient >4mm.
Data was analyzed with STATA. For dichotomous variables was used fisher´s test and chi2 and for quantitative variables t-student and U Mann Whitney.

Results

117 patients were studied.
In the AORIF group, 50 patients were included, 80% of them were male, 42 years old was the average age (±1,82 SD). None of them performed compartment syndrome prior to surgery. Surgery was performed with a median of 3 days [range 0-9] after the accident. None of these patients was complicated by compartment syndrome after surgery. Postoperatively, the most frequent complication was Deep Vein Thrombosis (DVT), with 14%, followed by superficial infections with 12%. Regarding the reduction, anatomical reduction was achieved in 58.8% of the patients, satisfactory in 40% of them and insufficient in 1.67%. There were two cases of delay in consolidation.
In the ORIF group of 60 patients, 88% of them were male and the average age was 47,5 years old. Surgery was performed with a median of 3 days (range 0-20). Three patients evolved with compartment syndrome prior to surgery. Regarding complications, like the AORIF group the most common was DVT with 23.3%, followed by surface infection with 13.3%.
Regarding the anatomical reduction, it was achieved in 58% of the patients, satisfactory in 40% of them and insufficient in 2%. There were two cases of delay in consolidation.
When comparing both groups in complications, there were no significant differences with DVT (p=0,2), infection (p=0,6), reduction (p=0,9), or compartment syndrome (p=0,1).

Conclusion

The use of arthroscopy in TPF, has been extensively studied in fractures type I to IV, but not so in those type V and VI.
The arthroscopic support in the TPF Schatzker V and VI, doesn’t show significant differences regarding the complications in comparison with the ORIF group.
The data allows us to determine, according to our experience, that the use of this technique, as a diagnostic and therapeutic tool of intraarticular injuries in TPF, seems like a safe alternative.