1.Evaluation of Radiological and Functional Outcome of Intra-articular Proximal Tibia Plateau Fracture Treated with Plating
Amin TK ; Patel I ; Jangad AH ; Shah H ; Vyas RP ; Patel NV ; Modi DR
Malaysian Orthopaedic Journal 2023;17(No.1):90-97
Introduction: Proximal tibial plateau fractures are one of
the major problems in orthopaedic surgery and are associated
with high complication rates. Intra-articular proximal tibia
plateau fractures represent approximately 1% of fractures in
adults. Various modalities of proximal tibial plateau fracture
management have been considered, ranging from simple
external fixators in impending compartment syndrome to
periarticular proximal tibia plates and inter-locking nails
with poller screws. Purpose of this study is to determine
clinical outcomes of proximal tibial plateau fractures treated
with plate.
Materials and methods: We did this study of proximal tibial
plateau fracture according to Schatzker’s classification
treated with proximal tibial periarticular plates in 53 patients
prospectively admitted at the author’s institute from June
2018 to May 2020 with follow-up period of 6 months.
Results: In our study, the average knee score was 89.30
(ranging from 79 to 93) and functional knee score was 97.92
(ranging from 75 to 100). Fifty-one (51) patients (96.23%)
showed excellent results and 2 patients (3.77%) showed
good results according to Knee Society Score, which suggest
that internal fixation of proximal tibia plateau fracture with
plating provides better results. Out of 53 patients, 9 patients
had post-operative complications. Average radiological
union was seen at 14 weeks.
Conclusion: Locking compression plate in proximal tibia
plateau fractures act as a good biological fixation provide
stable fixation, articular reduction and limb alignment even
in difficult fracture situations. Fixation of proximal tibia
plateau fractures with plate gives excellent to good knee
society score, with satisfactory functional and radiological
outcome.
2.Evaluation of Results of Open Reduction and Internal Fixation (ORIF) of Fracture of Distal End of Femur with Intra-Articular Extension
Amin TK ; Patel I ; Patel MJ ; Kazi MM ; Kachhad K ; Modi DR
Malaysian Orthopaedic Journal 2021;15(No.3):78-83
Introduction: Fractures of the distal femur account for 0.4%
of all fractures. They involve about 7% of all femur
fractures, with bimodal age distribution, commonly occur
during high-velocity trauma of motor vehicle accidents in the
younger group of patients and are frequently associated with
other skeletal injuries. The treatment of distal femoral
fractures has evolved from conservative treatment to more
aggressive operative treatment. The aim is to achieve and
maintain a good reduction of the joint to allow early active
mobilisation, thus minimising the joint stiffness and severe
muscular atrophy encountered in the conservative treatment.
Materials and methods: This is a retrospective study of 25
patients with distal femur fracture with intra-articular
extension treated with open reduction and internal fixation
with DFLP, admitted at our institute between 2016 to 2019,
with a minimum follow-up of six months.
Results: In our study, 19 (76%) patients had excellent to
good results. Three (12%) patients had fair outcomes, and
three (12%) patients had poor outcomes according to Neer’s
score. The average time for bone union in closed fractures
was earlier (4.25 months) than open fractures, averaging
5.86 months. The outcome was almost similar between
closed and open fractures. There were 2 (8%) cases of
infection in the early post-operative period, 7 (12%) patients
suffered from knee stiffness, and there were 3 (12%) cases
with a pre-operative bone loss that required bone grafting.
Conclusion: Management of complex intra-articular distal
femur fracture has always been a challenge. Anatomical
reduction of articular fragments and rigid fixation of these
fractures are a must. DFLP provides angular stability with
multiple options to secure fixation of both metaphyseal and
articular fragments with the restoration of the joint congruity,
limb length, alignment and rotation, allowing early
mobilisation and aggressive physiotherapy without loss of
fixation, resulting in gratifying functional outcome and low
complication rate.


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