Arthroscopic Treatment of Tibial Plateau Fractures John F. Meyers, M.D.

Advantages Visualize Fracture Remove Clot & Bone Fragments Identify & Treat Other Pathology Visualize Fracture Remove Clot & Bone Fragments Identify & Treat Other Pathology

Advantages Reduce Fracture Under Direct Visualization Minimize Soft Tissue Damage Reduce Fracture Under Direct Visualization Minimize Soft Tissue Damage

Indications Hohl Type I, II & III Selected Type IV & V Hohl Type I, II & III Selected Type IV & V

OR Setup General Anesthesia Supine Position Leg Holder High on Thigh General Anesthesia Supine Position Leg Holder High on Thigh

OR Setup Tourniquet Image Intensifier Tourniquet Image Intensifier

Arthroscopic Inspection Scope Anterolateral Medial Outflow Irrigate Joint Scope Anterolateral Medial Outflow Irrigate Joint

Arthroscopic Inspection Remove Clot & Bone Fragments Evaluate & Treat Associated Ligament & Meniscal Injuries Remove Clot & Bone Fragments Evaluate & Treat Associated Ligament & Meniscal Injuries

Fracture Reduction Transverse Drill Holes Drive Osteotome Under Fracture Elevate Fracture Transverse Drill Holes Drive Osteotome Under Fracture Elevate Fracture

Fixation 6.5mm Cannulated Cancellous Screws

Bone Graft Allograft Autograft Allograft Autograft

Post Op Quad & Hamstring Exercises Non-weight Bearing Until Fracture Healed Quad & Hamstring Exercises Non-weight Bearing Until Fracture Healed

Post Op CPM While in Hospital Hinged Brace CPM While in Hospital Hinged Brace

The Role of Arthroscopy in the Management of Tibial Plateau Fractures

R.B. Caspari, M.D. P.M.J. Hutton, M.D. T.L. Whipple, M.D. J.F. Meyers, M.D.

30 Fractures 1979 – 1984

13 Males 16 Females

Conservative Management Closed Reduction Casting / Bracing Traction / Suspension Early Motion Closed Reduction Casting / Bracing Traction / Suspension Early Motion

Operative Management Open Reduction Anatomical Restoration Internal Fixation Early Motion Open Reduction Anatomical Restoration Internal Fixation Early Motion

Mason Hohl JBJS – 1967

Age Range : 14 – 85 Years

Moore and Harvey JBJS – 1974

27 Acute Fractures 3 Old Fractures

Elstrom and Pankovich JBJS 1976

Soft Tissue Injuries 6 Fractures

Associated Soft Tissue Injuries Ligaments Meniscus Articular Cartilage Ligaments Meniscus Articular Cartilage

Soft Tissue Injuries Medial Meniscus 2 Lateral Meniscus 2 Medial Collateral 1 Anterior Cruciate1 Posterior Cruciate1 Medial Meniscus 2 Lateral Meniscus 2 Medial Collateral 1 Anterior Cruciate1 Posterior Cruciate1

No Significant Soft Tissue Injuries Cave Drennan, et. al. Moore, et. al. Rasmussen Rombold Cave Drennan, et. al. Moore, et. al. Rasmussen Rombold

Soft Tissue Injuries Aply Hohl, Et. Al. Martin Roberts Shelton Aply Hohl, Et. Al. Martin Roberts Shelton

Arthroscopy Low Risk Procedure Accurate Definition of Fx Soft Tissue Evaluation Low Risk Procedure Accurate Definition of Fx Soft Tissue Evaluation

Arthroscopy Reduction of Selected Fx Removal of Inter-articular Debris Post-healing Evaluation Reduction of Selected Fx Removal of Inter-articular Debris Post-healing Evaluation

Materials and Methods

30 Fractures 29 Patients

Hospitalization Operative Group : 10 – 12 Days Non-operative Group : 27 Days (avg.) Operative Group : 10 – 12 Days Non-operative Group : 27 Days (avg.)

Fracture Healing Non-operative Group 4 Mos Arthrotomy Group 4 Mos. Arthroscopy Group 1.8 Mos. Non-operative Group 4 Mos Arthrotomy Group 4 Mos. Arthroscopy Group 1.8 Mos.

Arthroscopy After Fracture Healing 4 Cases

Arthroscopy After Fracture Healing Mytosis Ossificans Loose Body Meniscectomy Abrasion Chondroplasty Mytosis Ossificans Loose Body Meniscectomy Abrasion Chondroplasty

1.Arthroscopy Is of Value in the Management of Tibial Plateau Fractures.

2. Acute Fractures and Associated Soft Tissue Injuries Can Be Precisely Defined, Allowing Timely Management Decisions.

Cast Immobilization Non Operative Groups : 5 wks. Arthrotomy Group : 4 wks. Arthroscopy Group : 10 days (9 Pts. – No Immobilization) Non Operative Groups : 5 wks. Arthrotomy Group : 4 wks. Arthroscopy Group : 10 days (9 Pts. – No Immobilization)

Functional Range of Motion (10 – 100°) Non Operative Group 4.3 Mos. Arthrotomy Group 3.0 Mos. Arthroscopy Group 1.3 Mos. Non Operative Group 4.3 Mos. Arthrotomy Group 3.0 Mos. Arthroscopy Group 1.3 Mos.

The Role of Arthroscopy in the Management of Tibial Plateau Fractures

Thank You !

Complications Peroneal Nerve 3 Delayed Union 1 Suture Abscess 1 Peroneal Nerve 3 Delayed Union 1 Suture Abscess 1

4. Healed, but Symptomatic Fractures May Benefit From Arthroscopic Surgery

3. Based on Direct Arthroscopic Observation, Selected Fractures Can Be Reduced and Stabilized, and Appropriate Post-operative Management Determined.

The Role of Arthroscopy in the Management of Tibial Plateau Fractures

Moore and Harvey JBJS – 1974

30 Fractures 1979 – 1984

Elstrom and Pankovich JBJS – 1976

Conservative Management Closed Reduction Casting / Bracing Traction / Suspension Early Motion Closed Reduction Casting / Bracing Traction / Suspension Early Motion

Operative Management Open Reduction Anatomical Restoration Internal Fixation Early Motion Open Reduction Anatomical Restoration Internal Fixation Early Motion

Mason Hohl JBJS – 1967

Associated Soft Tissue Injuries Ligaments Meniscus Articular Cartilage Ligaments Meniscus Articular Cartilage

30 Fractures 29 Patients

Materials and Methods

Arthroscopy Low Risk Procedure Accurate Definition of Fx Soft Tissue Evaluation Low Risk Procedure Accurate Definition of Fx Soft Tissue Evaluation

Soft Tissue Injuries Aply Hohl, Et Al. Martin Roberts Shelton Aply Hohl, Et Al. Martin Roberts Shelton

Results

Fracture Types Type I 10 Type II 1 Type III 8 Type IV 3 Type V 1 Type VI7 Type I 10 Type II 1 Type III 8 Type IV 3 Type V 1 Type VI7

ARIF/Grafting Type I 4 Type II 1 Type III8 Type IV1 Type V1 Type I 4 Type II 1 Type III8 Type IV1 Type V1

Patients Arthroscopic Surgery17 Arthrotomy (Alone) 4 Arthroscopy and Arthrotomy 3 Arthroscopic Surgery17 Arthrotomy (Alone) 4 Arthroscopy and Arthrotomy 3

Arthroscopic Procedures Diagnostic Exam 7 Debridement 3 Partial Meniscectomy 2 Closed Reduction1 ARIF and / or Graft 14 Diagnostic Exam 7 Debridement 3 Partial Meniscectomy 2 Closed Reduction1 ARIF and / or Graft 14

Arthroscopy and Arthrotomy ARIF / Meniscus Repair Arthroscopy / ORIF ORIF / Arthroscopy ARIF / Meniscus Repair Arthroscopy / ORIF ORIF / Arthroscopy

A.R.I.F. / B.G. AR and BG2 ARIF8 ARIF and BG3 ARIF and PMM1 AR and BG2 ARIF8 ARIF and BG3 ARIF and PMM1

Surgery – 24 Patients No Surgery – 5 Patients