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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe available evidence and surgical techniques that can be applied to the management of tibial plateau fractures, including unusual variants of these injuries, is addressed in this article.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHip \u0026amp; Knee Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHip \u0026amp; Knee Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe available evidence and surgical techniques that can be applied to the management of tibial plateau fractures, including unusual variants of these injuries, was addressed in a symposium.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ERoss K. Leighton, MD, Dalhousie University, Halifax, Nova Scotia, Canada, said that although autogenous cancellous bone graft has been referred to as the gold standard for the management of subarticular defect in tibial plateau fractures, no published studies support this contention. Autogenous iliac bone graft (AIBG) was compared with a bone substitute material (alpha-BSM), a calcium phosphate cement, in a randomized study to fill a defect void in 120 fractures of the lateral tibial plateau in 119 adults [Russell TA et al. \u003Cem\u003EJ Bone Joint Surg Am.\u003C\/em\u003E 2008]. All fractures underwent open reduction and internal fixation (ORIF) with use of standard non locking plate-fixation techniques. After reduction of the articular fracture, the subarticular defect was packed with either morselized corticocancellous AIBG or alpha-BSM.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThere was a trend toward an increase in knee extension and range of motion at 6 and 12 months, respectively, in the alpha-BSM group vs the cancellous bone graft group. In addition, there was a significantly higher rate of articular subsidence in the autogenous bone graft group compared with the alpha-BSM group at follow-up \u2265 12 months (\u003Cem\u003EP\u003C\/em\u003E = .009).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EProf Leighton noted that AIBG procurement requires a second surgical procedure with loss of previously uninjured tissues, which induces pain at the donor site, and iatrogenic complications are possible. He concluded that it should no longer be considered the gold standard for managing subarticular defects in tibial fracture plateaus.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the treatment of bicondylar tibial plateau fractures, consider the fracture morphology in the treatment strategy, said Paul Tornetta III, MD, Boston University, Boston, Massachusetts, USA. Tibial plateau fracture has various fracture patterns with differing degrees of articular displacement. Bicondylar tibial plateau fractures can be treated with locked plating applied from the lateral side or dual plating (addition of a medial plate). The medial fragment is the key in deciding which patients require a single plate or a dual plate. For patients with a posteromedial fragment, treatment with dual plating is associated with less loss of reduction compared with lateral locked plating. A large or axially stable medial fragment can be treated adequately with a locked plating technique.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe evidence is strong that the incidence of associated ligamentous injuries in tibial plateau fractures is high, said Aaron Nauth, MD, Queen\u0027s University, Toronto, Ontario, Canada. Unfortunately, there is little guidance on management in the literature and there is no direct evidence for surgical management. Surgical treatment decisions must be based on existing literature on isolated plateau fractures and multiligament injuries coupled with surgical principles, Prof Nauth said. From the literature on tibial plateau fracture, alignment and stability of the knee is an important principle. The literature with respect to isolated plateau fractures indicates that surgical treatment is generally associated with good outcomes. Operative treatment has been shown to be superior to nonoperative treatment of multiligament injuries, and reconstruction is generally preferred over repair.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EWith the goal of a stable, well-aligned knee, Prof Nauth\u0027s approach is to perform acute fixation of ligamentous avulsion injury whenever possible in combination with plateau fixation. Occasionally, he will reconstruct major ligamentous injuries acutely; otherwise, he does a delayed reconstruction.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EEmil H. Schemitsch, MD, University of Toronto, Toronto, Ontario, Canada, discussed the management of complications in tibial plateau surgery. Typical complications following tibial plateau fractures include infection, post-traumatic arthritis, stiffness, malunion or nonunion, painful hardware, and compartment syndrome\/neovascular injury.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EA surgical infection rate of 7.8% was reported for 256 consecutive cases of tibial plateau fractures [Lin S et al. Eur \u003Cem\u003EJ Orthop Surg Traumatol.\u003C\/em\u003E 2014]. Risk factors for infection are open fracture, smoking, and compartment syndrome requiring fasciotomy [Morris BJ et al. \u003Cem\u003EJ Orthop Trauma.\u003C\/em\u003E 2013]. Little Level I evidence exists for management of infection after a tibial plateau fracture; options include irrigation and debridement, targeted systemic antibiotic therapy, local antibiotic therapy, removal of hardware, revision of internal fixation\/external fixation, and a 2-stage revision total knee replacement. Multiple debridement procedures are usually necessary to eradicate infection, Prof Schemitsch said. In the setting of incomplete fracture healing, the management of implants is one of the challenges of acute infection. Irrigation and debridement and antibiotic therapy with retention of hardware were associated with resolution of infection in 71% of postoperative infection after ORIF of upper and lower extremity injuries [Berkes M et al. \u003Cem\u003EJ Bone Joint Surg Am.\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EExternal fixation can be used as definitive fixation in revision surgery. Stiffness following operative management of tibial plateau fractures is variably reported; stiffness requiring reoperation ranges from 0% to 5%. Knee stiffness requiring manipulation after periarticular fracture is related to the severity of injury. Prevention is the most effective intervention for avoidance of postoperative knee stiffness, and treatment (manipulation under anesthesia, arthroscopy, quadriceps-plasty) is largely dependent on the timing of presentation postoperatively. Joint incongruity can predispose to osteoarthritis after high-energy fractures; optimizing overall joint congruity and restoring the sagittal and coronal plane alignment should be emphasized, said Prof Schemitsch.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003ETotal knee arthroplasty after plateau fracture is uncommon as it often requires specialized techniques and implants, and it is associated with a high risk of perioperative complications as evidenced by a substantial rate of reoperation.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/41\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzom61\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}