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Posterior tibial plateau fracture treatment with the new WAVE posterior proximal tibia plate: feasibility and first results

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Operative management of posterior tibial plateau fractures (PTPF) remains challenging. The treatment goal is to restore the alignment and articular congruence, and providing sufficient stability which allows early mobilization. The purpose of this study was to assess the feasibility and safety of the newly developed WAVE posterior proximal tibia plate.

Methods

Between Oct 2017 and Jun 2020, 30 adult patients with a tibial plateau fracture and posterior involvement were selected for treatment with a WAVE posterior proximal tibia plate. Patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at time of injury (pre-injury) and at 1-year follow-up. Radiological outcome was evaluated with CT-imaging.

Results

Twenty-eight patients were eligible for treatment with the new implant (3 ‘one-column’, 10 ‘two column’ and 15 ‘three-column’ fractures), whereas in 2 patients anatomical fit was insufficient. KOOS results showed fair outcome scores at 1 year, with a large negative impact compared to pre-injury levels; however, a trend towards better results compared to a previous PTPF reference cohort. Radiological follow-up showed insufficient posterolateral buttress in two cases and residual articular step-off (> 2 mm) in seven patients, of which five were classified as three column fractures.

Conclusion

Management of PTPF using the WAVE posterior proximal tibia plate is feasible and safe with satisfactory clinical and radiological results after 1 year. Nevertheless, there is a learning curve regarding optimal implant positioning to achieve the maximum benefit of the implant.

Level of evidence

4.

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References

  1. Van den Berg JD, Quintens L, Zhan Y, Hoekstra H. Why address posterior tibial plateau fractures? Injury. 2020. https://doi.org/10.1016/j.injury.2020.09.011.

    Article  PubMed  Google Scholar 

  2. Jiwanlal A, Jeray KJ. Outcome of posterior Tibial plateau fixation. J Knee Surg. 2016;29:34–9. https://doi.org/10.1055/s-0035-1564729.

    Article  PubMed  Google Scholar 

  3. van den Berg J, Reul M, Nunes Cardozo M, et al. Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures. Int Orthop. 2017;41:1865–73. https://doi.org/10.1007/s00264-017-3566-3.

    Article  PubMed  Google Scholar 

  4. Luo C-F, Sun H, Zhang B, Zeng B-F. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010;24:683–92. https://doi.org/10.1097/BOT.0b013e3181d436f3.

    Article  PubMed  Google Scholar 

  5. Wang Y, Luo C, Zhu Y, et al. Updated three-column concept in surgical treatment for tibial plateau fractures—a prospective cohort study of 287 patients. Injury. 2016;47:1488–96. https://doi.org/10.1016/j.injury.2016.04.026.

    Article  PubMed  Google Scholar 

  6. 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. 2017;43:637–43. https://doi.org/10.1007/s00068-016-0696-z.

    Article  CAS  PubMed  Google Scholar 

  7. Van den Berg J, Struelens B, Nijs S, Hoekstra H. Value of three-dimensional computed tomography reconstruction in the treatment of posterior tibial plateau fractures. Knee. 2019;27(1):3–8. https://doi.org/10.1016/j.knee.2019.11.001.

    Article  PubMed  Google Scholar 

  8. 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;46:1613–8. https://doi.org/10.1016/j.injury.2015.05.005.

    Article  PubMed  Google Scholar 

  9. Pierrie SN, Harmer LS, Karunakar MA, et al. Limited added value of the posterolateral approach. J Knee Surg. 2016;29:21–7. https://doi.org/10.1055/s-0035-1564597.

    Article  PubMed  Google Scholar 

  10. Burks RT, Schaffer JJ. A simplified approach to the tibial attachment of the posterior cruciate ligament. Clin Orthop Relat Res. 1990;254:216–9. https://doi.org/10.1097/00003086-199005000-00031.

    Article  Google Scholar 

  11. Hoekstra H, Rosseels W, Luo C-F, Nijs S. A combined posterior reversed L-shaped and anterolateral approach for two column tibial plateau fractures in Caucasians: a technical note. Injury. 2015;46:2516–9. https://doi.org/10.1016/j.injury.2015.10.014.

    Article  CAS  PubMed  Google Scholar 

  12. Henry AK (1957) Extensile Exposure 2nd edn 1957, Churchill Livingstone, p 261

  13. Hoekstra Harm. Posteromedial reversed L-shaped approach for posterior column tibial plateau fractures (Version 1). 2018. Zenodo. https://doi.org/10.5281/zenodo.1470493.

  14. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64. https://doi.org/10.1186/1477-7525-1-64.

    Article  PubMed  PubMed Central  Google Scholar 

  15. van den Berg J, Nijs S, Hoekstra H. Limited value of the column concept in the operative management of posterior column tibial plateau fractures. Eur J Trauma Emerg Surg. 2019;46(5):1143–50. https://doi.org/10.1007/s00068-019-01078-5.

    Article  PubMed  Google Scholar 

  16. Metsemakers WJ, Morgenstern M, McNally MA, et al. Fracture-related infection: a consensus on definition from an international expert group. Injury. 2017;49(3):505–10. https://doi.org/10.1016/j.injury.2017.08.040.

    Article  PubMed  Google Scholar 

  17. Quintens L, Van den Berg J, Reul M, et al. Poor sporting abilities after tibial plateau fractures involving the posterior column: how can we do better? Eur J Trauma Emerg Surg. 2019;47(1):201–9. https://doi.org/10.1007/s00068-019-01220-3.

    Article  PubMed  Google Scholar 

  18. Reul M, Hoekstra H (2017) Der kombinierte posteromediale und anterolaterale Zugang in der „ floating “-Position zur operativen Versorgung Combined Posteromedial and Anterolateral Approach in the “ floating position ”– Two Column Fracture of the Tibia Head Einleitung Material und. 661–669

  19. Quintens L, Herteleer M, Vancleef S, et al. Anatomical variation of the Tibia–a principal component analysis. Sci Rep. 2019;9:1–10. https://doi.org/10.1038/s41598-019-44092-8.

    Article  CAS  Google Scholar 

  20. Krause M, Preiss A, Muller G, et al. Intra-articular tibial plateau fracture characteristics according to the “Ten segment classification.” Injury. 2016;47:2551–7. https://doi.org/10.1016/j.injury.2016.09.014.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium

    Juriaan Van den Berg, Olivier Vinckier, Stefaan Nijs & Harm Hoekstra

  2. Department of Orthopedics and Traumatology, VU Brussel-Free University of Brussels, Brussels, Belgium

    Maike Reul

  3. Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands

    Robert Jan Derksen

  4. Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium

    Stefaan Nijs & Harm Hoekstra

  5. Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Michiel Verhofstad

Authors
  1. Juriaan Van den Berg
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  2. Maike Reul
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  3. Olivier Vinckier
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  4. Robert Jan Derksen
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  5. Stefaan Nijs
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  6. Michiel Verhofstad
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  7. Harm Hoekstra
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Corresponding author

Correspondence to Harm Hoekstra.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval for this study was granted by the Research Ethics Committee UHL/KU Leuven and registered as: S60860. This study was completed in compliance with national legislation and the guidelines of the ethics committee of the University Hospitals Leuven.

Informed consent

There was informed consent obtained from all individual participants included in this study.

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den Berg, J.V., Reul, M., Vinckier, O. et al. Posterior tibial plateau fracture treatment with the new WAVE posterior proximal tibia plate: feasibility and first results. Eur J Trauma Emerg Surg 48, 1285–1294 (2022). https://doi.org/10.1007/s00068-021-01639-7

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  • DOI: https://doi.org/10.1007/s00068-021-01639-7

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