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. 2023 Jun;49(3):1433-1439.
doi: 10.1007/s00068-022-02188-3. Epub 2022 Dec 9.

Nanoscopy and an extended lateral approach can improve the management of latero-central segments in tibial plateau fractures: a cadaveric study

Peter Behrendt  1   2   3 , M T Berninger  4 , G Thürig  4   5 , J Dehoust  6 , J Christensen  7 , K-H Frosch  4   6 , M Krause  4 , M J Hartel  4   6
Affiliations

Nanoscopy and an extended lateral approach can improve the management of latero-central segments in tibial plateau fractures: a cadaveric study

Peter Behrendt et al. Eur J Trauma Emerg Surg. 2023 Jun.

Abstract

Introduction: The objective of this investigation was to compare different techniques to improve visualization and reduction in tibial plateau fractures involving the central lateral segments.

Methods: Matched pairs of pre-fractured cadaveric tibial plateau fractures that include the central lateral segments were treated by either an anterolateral approach (supine) or PL approach (prone). Reduction was stepwise extended by additional fracturoscopy (FS), nanoscopy (NS) and lastly by epicondyle osteotomy (ECO). Reduction was analyzed by 3D scan and visualization of the lateral plateau was quantified.

Results: Ten specimens (3 pairs 41B3.1, 2 pairs 41C3.3) were analyzed. Fracture steps involving the antero-latero-central (ALC) segment were insufficiently reduced after fluoroscopy using both approaches (AL 2.2 ± 1.2 mm vs PL 2.2 ± 1.0 mm, p 0.95). Additional NS and ECO achieved optimized fracture reduction in the ALC segment (NS AL 1.6 ± 1.3 mm vs PL 0.8 ± 0.9 mm, p 0.32). NS provided visualization of the entire lateral plateau (PL 102.9% ± 7.4, AL 108.8 ± 19.2%), while fracturoscopy only allowed visualization of the ALL segment and partially of PLL and ALC segments (PL 22.0 ± 23.4%, AL 29.7 ± 18.3%).

Conclusion: Optimized reduction of tibial head fractures with involvement of latero-central segments requires additional video-assisted reduction or extended approaches. Nanoscopy helps visualizing of the entire lateral plateau, when compared to fracturoscopy and may become a valuable reduction aid.

Keywords: Fracture; Nanoscope; Posterolateral approach; Prone; Supine; Tibia.

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Conflict of interest statement

The authors declare that this study was financially supported by Arthrex Inc. and Siemens. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. PB was recipient of a fellowship of the German Knee Society sponsored by Arthrex Inc.

Figures

Fig. 1
Fig. 1
Flowchart of the fracture reduction and fixation. Matched pairs of pre-fractured specimens were randomized to be approached by either an anterolateral (AL) or posterolateral (PL) approach. Following open reduction and satisfying fluoroscopic control, a concealed 3D scan was recorded. Afterwards, fracturoscopy (FS) and nanoscopy (NS) were utilized to optimize the fracture reduction. Afterwards, an additional concealed 3D scan was recorded. Finally, an epicondyle osteotomy (ECO) was performed to further optimize the fracture reduction and final fixation was performed. In the end, another 3D scan was recorded
Fig. 2
Fig. 2
Tibial plateau visualization by fracturoscopy (FS) and nanoscopy (NS)
Fig. 3
Fig. 3
Reduction control by fracturoscopy and nanoscopy. Fracturoscopy (A, B) provides visual fracture reduction control of the peripheral aspect of the antero-latero-lateral (ALL) segment, while with nanoscopy (E, F) the fracture can be visualized even in a narrow joint compartment up to the antero-latero-central and postero-latero-central segment. Thereby, fractures involving the ALC/PLC segment (C, D) can be visualized and reduction can be optimized under visual control (F–H). An epicondyle osteotomy (H) was only performed due to the study protocol, but no further reduction was necessary in this case
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References

    1. Krause M, Preiss A, Müller G, Madert J, Fehske K, Neumann MV, Domnick C, Raschke M, Südkamp N, Frosch KH. Intra-articular tibial plateau fracture characteristics according to the "Ten segment classification". Injury. 2016;47:2551–2557. doi: 10.1016/j.injury.2016.09.014. - DOI - PubMed
    1. Krause M, Müller G, Frosch KH. Surgical approaches to tibial plateau fractures. Unfallchirurg. 2018;121:569–582. doi: 10.1007/s00113-018-0515-6. - DOI - PubMed
    1. Krause M, Krüger S, Müller G, Püschel K, Frosch KH. How can the articular surface of the tibial plateau be best exposed? A comparison of specific surgical approaches. Arch Orthop Trauma Surg. 2019;139:1369–1377. doi: 10.1007/s00402-019-03200-z. - DOI - PubMed
    1. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21:S1–133. doi: 10.1097/00005131-200711101-00001. - DOI - PubMed
    1. Singleton N, Sahakian V, Muir D. Outcome after tibial plateau fracture: how important is restoration of articular congruity? J Orthop Trauma. 2017;31:158–163. doi: 10.1097/bot.0000000000000762. - DOI - PubMed