an evaluation of tibia plateau fracture managed surgically with ..

ASSOCIATED INJURIES :
Compound fracturess were found in 2 patients which were managed by external fixator and plastic surgery intervention and final fixation with locked plates . One patient had distal end radius fracture which was managed by closed reduction and K wire fixation.
One patient had left humerus fracture who underwent plating for the same.
One patient had Patella fracture, managed by ORIF with TBW
Two patients had fracture of ipsilateral Lateral femoral condyle, fixed with two 4.5 mm CC screws
Three patients had fracture of tibia shaft treated with Interlock nailing
Two patients had fracture shaft femur treated with Interlock nailing
One patient had compression fracture of D12 Vertebra, managed conservatively.
One patient had ipsilateral Popliteal artery thrombosis ,managed with embolectomy by CVTS doctors
One patient had Head injury, managed by Neurosurgeons.
COMPLICATIONS :
Complications are divided into pre-operative & post operative ; and post operative complications are further divided into septic and non septic types.
Pre operative –
Out of 30 patients 2 patients had compound fracture grade IIIB (Pt 27) and grade IIIC(Pt.19). Both patients were schatzker type VI. External fixator was applied to 2 patients. The aim of temporary spanning external fixation was, soft tissue healing. Local flaps used to cover the wound at a later date and final fixation with locked plates was done after complete wound healing (pt 21-154 days & pt 27 – 60 days)
Popliteal artery thrombosis was diagnosed in one patient (pt -21).External fixator was applied in this patient. Time taken from the trauma to definitive fixation in this patient was 154 days
The decision to proceed with definitive fixation was based on the patient's medical fitness and recovery of the soft-tissue envelope. This staged treatment was individualized and based on the attending surgeon's experience and judgment in identifying satisfactory soft-tissue recovery. Specific clinical signs aiding in this decision included resolution of edema and fracture blisters and the return of skin wrinkling .Final results was excellent in one patient(pt.27) & fair in 1 patient(pt.21)
Post operative complications
Nonseptic Complications
Complications requiring surgical interventions due to implant failure/breakage was not seen in our study.
Septic Complications
Six patients developed superficial wound complications that responded to daily dressing and antibiotics. Deep wound infections occurred in 6 patients. Three patients (pt 10,20,26) responded to intravenous antibiotics as per culture and senility report & plastic surgery intervention ; and implant removal was required in other 3 patients(pt.13,24,28). Using the Fisher exact test, patient gender, age, use of temporary spanning external fixation, and compound fractures were not found to be statistically associated with the development of infection. The time delay to definitive surgery and patient age were similarly not found to be significantly associated with the development of deep infection.
CLINICAL RESULTS (According to Rassmussen's Knee Scoring System):
In our series Excellent results were achieved in 17 cases (56.67%), Good results in 9 cases (30%) and Fair in 4 cases (13.33%).

There is high morbidity associated with deep SSI in plated proximal tibial fractures.

Acquired Immunodeficiency Syndrome caused by the Human Immunodeficiency Virus (HIV) is today one of the most common cause of secondary immunodeficiency. The AIDS pandemic is fast spreading across the globe. In India, 40,00,000 people have AIDS / HIV with a prevalence of 0.8 %33. AIDS is the end result of a progressively decreased immunological competence caused by HIV. The Human immunodeficiency virus damages and progressively destroys the immune system by interacting with the CD4 subset of helper T- cells and using them for replication. This results in an immunocompromised state in an individual infected with HIV and renders him susceptible to a variety of infections and diseases. It is highly likely that like any other illness of chronic nature, HIV infection may affect or actually retard the healing process necessary for convalescence. Fracture and soft tissue hjhjhnealing rates may be expected to suffer in HIV infected patients, more so in those with signs of AIDS-related complex. Owing to its immunosuppressive nature, the possibility or likelihood of postoperative infections should logically increase.


tibia plateau fracture managed surgically with buttress ..

Another focus was on the incidence of concomitant injuries after the most common lateral plateau fracture type and the need for MRI as a diagnostic tool when treating these fractures.