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

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

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

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

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

8. OR Setup Tourniquet Image Intensifier Tourniquet Image Intensifier

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

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

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

21. Fixation 6.5mm Cannulated Cancellous Screws

27. Bone Graft Allograft Autograft Allograft Autograft

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

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

47. The Role of Arthroscopy in the Management of Tibial Plateau Fractures

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

49. 30 Fractures 1979 – 1984

50. 13 Males 16 Females

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

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

53. Mason Hohl JBJS – 1967

54. Age Range : 14 – 85 Years

55. Moore and Harvey JBJS – 1974

56. 27 Acute Fractures 3 Old Fractures

57. Elstrom and Pankovich JBJS 1976

58. Soft Tissue Injuries 6 Fractures

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

60. 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

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

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

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

64. 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

65. Materials and Methods

66. 30 Fractures 29 Patients

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

68. 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.

69. Arthroscopy After Fracture Healing 4 Cases

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

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

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

73. 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)

74. 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.

75. The Role of Arthroscopy in the Management of Tibial Plateau Fractures

76. Thank You !

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

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

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

84. The Role of Arthroscopy in the Management of Tibial Plateau Fractures

85. Moore and Harvey JBJS – 1974

86. 30 Fractures 1979 – 1984

87. Elstrom and Pankovich JBJS – 1976

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

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

90. Mason Hohl JBJS – 1967

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

92. 30 Fractures 29 Patients

93. Materials and Methods

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

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

96. Results

97. 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

98. 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

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

100. 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

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

102. 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

103. Surgery – 24 Patients No Surgery – 5 Patients