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Z Orthop Unfall 2017; 155(03): 352-370
DOI: 10.1055/s-0042-116779
CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Intraartikuläre Tibiakopffrakturen

Intra-articulair tibial Plateau Fractures
Maike Reul
,
Stefaan Nijs
,
Pol Maria Rommens
,
Harm Hoekstra
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Publikationsverlauf

Publikationsdatum:
06. Juli 2017 (online)

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Zusammenfassung

Tibiakopffrakturen sind komplexe Gelenkfrakturen, deren adäquate Behandlung eine dezidierte klinische und radiologische Diagnostik erfordert. Bei der Behandlung hat sich das 3-Pfeiler-Konzept als ausgezeichnetes chirurgisches Planungsinstrument dieses komplexen Traumas erwiesen. Der Standard der Therapie ist die offene interne Stabilisierung (ORIF) mit anatomischer Rekonstruktion des Gelenks. Bei der Wahl der korrekten Behandlungsstrategie können gute funktionelle Resultate erreicht werden.

Tibiakopffrakturen sind Gelenkfrakturen, deren adäquate Behandlung eine dezidierte klinische und radiologische Diagnostik erfordert. Bei der Behandlung hat sich das 3-Pfeiler-Konzept als ausgezeichnetes chirurgisches Planungsinstrument dieses komplexen Traumas erwiesen. Der Standard der Therapie ist die offene interne Stabilisierung (ORIF) mit anatomischer Rekonstruktion des Gelenks. Bei Wahl der korrekten Behandlungsstrategie können gute funktionelle Resultate erreicht werden.

Abstract

Tibial plateau fractures are complex articular injuries, especially if caused by high energy. For adequate treatment a decidedly clinical and radiographic diagnostic is required. The three-column-concept has proven as excellent surgical planningstool in this complex trauma. By (1) precisely considering the specific characteristics of the fracture, (2) careful treatment of soft-tissue envelope and (3) choosing the right treatment strategy, a good functional outcome can be achieved.

Kernaussagen

  • Die Therapie der intraartikulären Tibiakopffraktur ist für den Chirurgen eine Herausforderung.

  • Ein adäquates diagnostisches Work-up mit korrekter Analyse der Frakturmorphologie und Klassifikation sowie eine kritische Betrachtung der Verletzung der Weichteile ist von entscheidender Bedeutung. Hierfür ist die Durchführung eines präoperativen CT unabdingbar.

  • Das 3-Pfeiler-Konzept hat sich als ein ausgezeichnetes chirurgisches Planungsinstrument erwiesen und sollte bei der Wahl der operativen Behandlungsstrategie genutzt werden.

  • Die offene interne Stabilisierung (ORIF) mit anatomischer Rekonstruktion des Gelenks ist der Standard in der Behandlung intraartikulärer Tibiakopffrakturen.

  • Gute Ergebnisse mit geringen Komplikationsraten können erzielt werden durch

    • gute Therapieplanung,

    • Beachtung der Weichteilsituation,

    • an die Fraktur angepasste Wahl des richtigen operativen Zugangswegs,

    • richtige Wahl der zum Einsatz kommenden Implantate.

Schlüsselwörter

Tibiakopffraktur - Frakturmorphologie - 3-Pfeiler-Konzept - Osteosynthese - funktionelles Ergebnis

Key words

tibial plateau fracture - fracture morphology - three-column-concept - osteosynthesis - functional outcome
 

  • Literatur

  • 1 Krieg JC. Proximal tibial fractures: current treatment, results, and problems. Injury 2003; 34 (Suppl. 01) A2-A10
    CrossrefPubMedSuche in Google Scholar
  • 2 Pape HC, Rommens PM. Tibia proximal. In: Rüedi TP, Buckley RE, Moran CG. eds. AO Principles of Fracture Management. 2nd ed.. Stuttgart: Thieme; 2007: 815-834
    Suche in Google Scholar
  • 3 Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma 1987; 1: 97-119
    CrossrefPubMedSuche in Google Scholar
  • 4 Albuquerque RPE, Hara R, Prado J. et al. Epidemiological study on tibial plateau fractures at a level I trauma center. Acta Ortoped Bras 2013; 21: 109-115
    PubMedSuche in Google Scholar
  • 5 Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37: 691-697
    CrossrefPubMedSuche in Google Scholar
  • 6 Yang G, Zhai Q, Zhu Y. et al. The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system. Arch Orthop Trauma Surg 2013; 133: 929-934
    CrossrefPubMedSuche in Google Scholar
  • 7 Zhu Y, Meili S, Dong MJ. et al. Pathoanatomy and incidence of the posterolateral fractures in bicondylar tibial plateau fractures: a clinical computed tomography-based measurement and the associated biomechanical model simulation. Arch Orthop Trauma Surg 2014; 134: 1369-1380
    CrossrefPubMedSuche in Google Scholar
  • 8 Sun H, Luo CF, Yang G. et al. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol 2013; 23: 809-818
    CrossrefPubMedSuche in Google Scholar
  • 9 Zimmermann V. Tibiakopffrakturen im Wintersport. Aktuelle Behandlungsoptionen. Unfallchirurg 2014; 117: 41-47
    CrossrefPubMedSuche in Google Scholar
  • 10 Abdel-Hamid MZ, Chang CH, Chan YS. et al. Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases. Arthroscopy 2006; 22: 669-675
    CrossrefPubMedSuche in Google Scholar
  • 11 Gardner MJ, Yacoubian S, Geller D. et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma 2005; 19: 79-84
    CrossrefPubMedSuche in Google Scholar
  • 12 Stannard JP, Lopez R, Volgas D. Soft tissue injury of the knee after tibial plateau fractures. J Knee Surg 2010; 23: 187-192
    Thieme ConnectPubMedSuche in Google Scholar
  • 13 Papagelopoulos PJ, Partsinevelos A, Themistocleous GS. et al. Complications after tibia plateau fracture surgery. Injury 2006; 37: 475-484
    CrossrefPubMedSuche in Google Scholar
  • 14 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 1979; 138: 94-104
    PubMedSuche in Google Scholar
  • 15 Markhardt BK, Gross JM, Monu JUV. Schatzker classification of tibial plateau fractures: use of CT and MR imaging improves assessment. Radiographics 2009; 29: 585-597
    CrossrefPubMedSuche in Google Scholar
  • 16 Müller ME. Müller AO Classification of Fractures – long Bones. Berlin, Heidelberg, New York: Springer; 1987
    Suche in Google Scholar
  • 17 Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive Classification of Fractures of long Bones. Berlin, Heidelberg: Springer; 1990: 120-121
    Suche in Google Scholar
  • 18 Luo CF, Sun H, Zhang B. et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 2010; 24: 683-692
    CrossrefPubMedSuche in Google Scholar
  • 19 Zhu Y, Yang G, Luo CF. et al. Computed tomography-based Three-Column Classification in tibial plateau fractures. J Trauma Acute Care Surg 2012; 73: 731-737
    CrossrefPubMedSuche in Google Scholar
  • 20 Hoekstra H, Kempenaers K, Nijs S. A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures. Eur J Trauma Emerg Surg 2016;
    CrossrefPubMedSuche in Google Scholar
  • 21 Zhu Y, Hu CF, Yang G. et al. Inter-observer reliability assessment of the Schatzker, AO/OTA and three-column classification of tibial plateau fractures. J Trauma Manag Outcomes 2013; 7: 7
    CrossrefPubMedSuche in Google Scholar
  • 22 Patange Subba Rao SP, Lewis J. et al. Three-column classification and Schatzker classification: a three- and two-dimensional computed tomography characterisation and analysis of tibial plateau fractures. Eur J Orthop Surg Traumatol 2014; 24: 1263-1270
    CrossrefPubMedSuche in Google Scholar
  • 23 Brunner A, Horisberger M, Ulmar B. et al. Classification systems for tibial plateau fractures; does computed tomography scanning improve their reliability?. Injury 2010; 41: 173-178
    CrossrefPubMedSuche in Google Scholar
  • 24 Charalambous C, Tryfonidis M, Alvi F. et al. Inter- and intra-observer variation of the Schatzker and AO/OTA classifications of tibial plateau fractures and a proposal of a new classification system. Ann R Coll Surg Engl 2007; 89: 400-404
    CrossrefPubMedSuche in Google Scholar
  • 25 Walton NP, Harish S, Roberts C. et al. AO or Schatzker? How reliable is classification of tibial plateau fractures?. Arch Orthop Trauma Surg 2003; 123: 396-398
    CrossrefPubMedSuche in Google Scholar
  • 26 Tscherne H, Oestern H. A new classification of soft-tissue damage in open and closed fractures. Unfallheilkunde 1972; 85: 111-115
    PubMedSuche in Google Scholar
  • 27 Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58: 453-458
    CrossrefPubMedSuche in Google Scholar
  • 28 Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24: 742-746
    CrossrefPubMedSuche in Google Scholar
  • 29 Moore TM. Fracture – dislocation of the knee. Clin Orthop Relat Res 1981; 156: 128-140
    PubMedSuche in Google Scholar
  • 30 Bobrich E, Haupt C, Grass R. et al. Tibiakopffraktur und Luxationsfraktur: Klassifikation und Begleitverletzungen. Trauma Berufskrankh 2009; 11 (Suppl. 02) S154-S159
    CrossrefPubMedSuche in Google Scholar
  • 31 DeCoster T, Nepola JV, el-Khoury GY. Cast brace treatment of proximal tibia fractures. A ten-year follow-up study. Clin Orthop Relat Res 1988; 231: 196-204
    PubMedSuche in Google Scholar
  • 32 Brown GA, Sprague BL. Cast brace treatment of plateau and bicondylar fractures of the proximal tibia. Clin Orthop Relat Res 1976; 119: 184-193
    PubMedSuche in Google Scholar
  • 33 Jensen DB, Rude C, Duus B. et al. Tibial plateau fractures. A comparison of conservative and surgical treatment. J Bone Joint Surg Br 1990; 72: 49-52
    PubMedSuche in Google Scholar
  • 34 Kandemir U, Maclean J. Surgical approaches for tibial plateau fractures. J Knee Surg 2014; 27: 21-29
    PubMedSuche in Google Scholar
  • 35 Chen HW, Luo CF. Extended anterolateral approach for treatment of posterolateral tibial plateau fractures improves operative procedure and patient prognosis. Int J Clin Exp Med 2015; 8: 13708-13715
    PubMedSuche in Google Scholar
  • 36 He X, Ye P, Hu Y. A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures. Arch Orthop Trauma Surg 2013; 133: 23-28
    CrossrefPubMedSuche in Google Scholar
  • 37 Qiu WJ, Zhan Y, Sun H. et al. A posterior reversed L-shaped approach for the tibial plateau fractures – A prospective study of complications (95 cases). Injury 2015; 46: 1613-1618
    CrossrefPubMedSuche in Google Scholar
  • 38 Sun H, Zhai QL, Xu XF. et al. Combined approaches for fixation of Schatzker type II tibial plateau fractures involving the posterolateral column: a prospective observational cohort study. Arch Orthop Trauma Surg 2015; 135: 209-221
    CrossrefPubMedSuche in Google Scholar
  • 39 Pierrie SN, Harmer LS, Karunakar MA. et al. Limited added value of the posterolateral approach. J Knee Surg 2015; 29: 21-27
    Thieme ConnectPubMedSuche in Google Scholar
  • 40 Lobenhoffer P, Gerich T, Bertram T. et al. Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg 1997; 100: 957-967
    CrossrefPubMedSuche in Google Scholar
  • 41 Lobenhoffer P. Posterolateral transfibular approach to tibial plateau fractures. J Orthop Trauma 2011; 25: e31
    Suche in Google Scholar
  • 42 Yu B, Han K, Zhan C. et al. Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee 2010; 17: 313-318
    CrossrefPubMedSuche in Google Scholar
  • 43 Frosch KH, Balcarek P, Walde T. et al. A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma 2010; 24: 515-520
    CrossrefPubMedSuche in Google Scholar
  • 44 Cole PA, Zlowodzki M, Kregor PJ. Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma 2004; 18: 528-535
    CrossrefPubMedSuche in Google Scholar
  • 45 Devkota P, Manandhar HK, Khadka PB. et al. Less invasive stabilization system for the management of proximal tibia fractures. Eur J Orthop Surg Traumatol 2014; 24: 993-998
    CrossrefPubMedSuche in Google Scholar
  • 46 Cole PA, Hiesterman TG, Shafiq BX. et al. Intramedullary nailing of extra- articular proximal tibia fractures. J Am Acad Orthop Surg 2011; 19: 690-700
    CrossrefPubMedSuche in Google Scholar
  • 47 Herbort M, Domnick C, Petersen W. Arthroscopic treatment of tibial plateau fractures. Oper Orthop Traumatol 2014; 26: 573-588
    CrossrefPubMedSuche in Google Scholar
  • 48 Burdin G. Arthroscopic management of tibial plateau fractures: surgical technique. Orthop Traumatol Surg Res 2013; 99 (1 Suppl.): S208-S218
    CrossrefPubMedSuche in Google Scholar
  • 49 Frosch KH, Preiss A, Heider S. et al. Primary ligament sutures as a treatment option of knee dislocations: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2013; 21: 1502-1509
    CrossrefPubMedSuche in Google Scholar
  • 50 Heitmann M, Gerau M, Hötzel J. et al. Ligament bracing – augmented primary suture repair in multiligamentous knee injuries. Oper Orthop Traumatol 2014; 26: 19-29
    CrossrefPubMedSuche in Google Scholar
  • 51 van Dreumel RLM, van Wunnik BPW, Janssen L. et al. Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures. Injury 2015; 46: 1608-1612
    CrossrefPubMedSuche in Google Scholar
  • 52 Jansen H, Frey SP, Doht S. et al. Medium-term results after complex intra-articular fractures of the tibial plateau. J Orthop Sci 2013; 18: 569-577
    CrossrefPubMedSuche in Google Scholar
  • 53 Manidakis N, Dosani A, Dimitriou R. et al. Tibial plateau fractures: Functional outcome and incidence of osteoarthritis in 125 cases. Int Orthop 2010; 34: 565-570
    CrossrefPubMedSuche in Google Scholar
  • 54 Elsøe R, Larsen P, Rasmussen S. et al. High degree of patient satisfaction after percutaneous treatment of lateral tibia plateau fractures. Danish Med J 2016; 63: 6-11
    PubMedSuche in Google Scholar
  • 55 Barei DP, Nork SE, Mills WJ. et al. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am 2006; 88: 1713-1721
    CrossrefPubMedSuche in Google Scholar
  • 56 Ebraheim NA, Sabry FF, Haman SP. Open reduction and internal fixation of 117 tibial plateau fractures. Orthopedics 2004; 27: 1281-1287
    PubMedSuche in Google Scholar
  • 57 Canadian Orthopaedic Trauma Society. 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 2006; 88: 2613-2623
    CrossrefPubMedSuche in Google Scholar
  • 58 Rademakers MV, Kerkhoffs GM, Sierevelt IN. et al. Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 2007; 21: 5-10
    CrossrefPubMedSuche in Google Scholar
  • 59 Wasserstein D, Henry P, Paterson JM. et al. Risk of total knee arthroplasty after operatively treated tibial plateau fracture: a matched-population-based cohort study. J Bone Joint Surg Am 2014; 96: 144-150
    CrossrefPubMedSuche in Google Scholar
  • 60 Giannoudis PV, Tzioupis C, Papathanassopoulos A. et al. Articular step-off and risk of post-traumatic osteoarthritis. Evidence today. Injury 2010; 41: 986-995
    CrossrefPubMedSuche in Google Scholar