Versorgung kn?cherner hinterer Kreuzbandausrisse über einen minimal-invasiven dorsalen Zugang

Objective

Reduction and fixation of bony avulsions of the posterior cruciate ligament (PCL) through a minimally invasive dorsal approach to restore stability of the knee joint. Prevention of soft tissue damage through a minimally invasive procedure and achieving early functional rehabilitation by stable osteosynthesis.

Indications

Bony tibial avulsions of the PCL and simple posteromedial tibial fractures.

Contraindications

Infections in or around the knee, critical soft tissue conditions and lack of patient compliance.

Operation technique

Supine position, skin incision mediodorsal over the head of the medial gastrocnemius muscle. After dissection of soft tissue and superficial fascia the medial gasteocnemius muscle is retracted to the lateral side, nerves and vessels of the popliteal fossa are thereby protected. Incision of the posterior capsule from the tibial attachment, exposure of the fracture and the PCL, reduction of the fracture, fixation with two drill wires and definitive fixation with two cannulated screws. In case of multifragment fracture a suture anchor is used for fixation.

Postoperative management

Partial weight bearing of 10–20?kg for 4–6 weeks and limitation of knee flexion up to 90° for 4 weeks.

Results

Between November 2010 and November 2011 three patients were treated with the new minimally invasive posteromedial approach to fix bony avulsions of the PCL. In two cases an osteosynthesis with two screws was performed and in the other patient a comminuted avulsion fracture was fixed with a suture anchor. In the latter patient the posterolateral corner was additionally augmented according to Larson with an autologous semitendinosus tendon. No intraoperative or postoperative complications could be observed. In all three patients an excellent fracture reduction without steps or gaps could be achieved. In two cases an early functional treatment protocol and in one case (suture anchor fixation plus augmentation of the posterolateral corner) a special postoperative PCL rehabilitation protocol was used. Good clinical results with stable knee joints could be achieved in all cases. The minimally invasive dorsal approach for the treatment of bony avulsions of the PCL was demonstrated to be safe and simple with a low complication rate.     

Delayed detection of clinically significant posterior cruciate ligament injury after peri-articular fracture around the knee of 448 patients

Background

The purpose of this study was to report the frequency with which posterior cruciate ligament (PCL) injuries occurred in combination with peri-articular fractures around the knee, and to determine the frequency with which the detection of these PCL injuries was delayed (i.e., detected in an outpatient clinic after fracture treatment).

Methods

This retrospective study included 448 subjects with peri-articular fractures around the knee, including femoral shaft fractures, distal femoral fractures, patellar fractures, tibial plateau fractures, and tibial shaft fractures. The PCL injuries were detected through clinical examination, magnetic resonance imaging, and stress X-rays. We determined both the frequency of PCL injuries that occurred in combination with peri-articular fractures around the knee, and the frequency with which the detection of these PCL injuries was delayed. We also compared the frequency with which PCL injuries were associated with either isolated or combined fractures for different fracture types.

Results

We identified concomitant PCL injury and peri-articular fracture of the knee in 7.8?% of patients. In 22 of the 35 patients with concomitant PCL injury, the detection of the PCL injury was delayed. There were significant differences in the frequency with which PCL injuries were associated with isolated or combined fractures of the femoral shaft (P?=?0.04), patella (P?=?0.03), and distal femur (P?=?0.03).

Conclusion

The delayed detection frequency was high for PCL injury after peri-articular fracture around the knee.     

Ein modifizierter posterolateraler Zugang für die operative Versorgung von Tibiakopffrakturen

Objective

Open reduction and internal fixation of posterolateral tibial plateau fractures.

Indications

Tibial plateau fractures involving the posterolateral quadrant.

Contraindications

Critical soft-tissue conditions. Tibial plateau fractures which do not involve the posterolateral quadrant.

Surgical Technique

90° side positioning on the contralateral side, skin incision along the fibular head, exposure of the peroneal nerve, lateral arthrotomy and exposure of the joint, dissection of the popliteal cavity between the lateral head of the gastrocnemius muscle and soleus muscle. Blunt preparation between popliteus muscle and soleus muscle under preservation of the popliteal artery and vein. Sharp dissection of the soleus muscle from the dorsal parts of fibula and tibia until the peroneal nerve at the fibular neck enters into the muscle. Exposure of the posterolateral tibial head. The dorsal joint capsule and the popliteal corner are prevented from any soft-tissue damage. Visual control of fracture reduction by viewing in the joint gap through lateral arthrotomy. Reduction of the fracture from dorsal with pointed reduction forceps. A conventional or locking radius T-plate can be pinched off with lateral cutters and anatomically bent for fracture fixation and is dorsally fixed at the tibial plateau.

Postoperative Management

10 kg partial weight bearing for 6–8 weeks. Limited range of motion 0-0-90° for 6 weeks.

Results

In a period of 2 years, seven patients with posterolateral tibial plateau fractures received open reduction and internal fixation by using the modified posterolateral approach. The patients were examined at follow-up between 12 and 24 months after surgery. Six patients were free of pain with full range of motion and stable knee joints. Radiologically, a good fracture reduction was achieved in six cases. In one patient with a posterolateral comminuted dislocation fracture, a small fracture step and a gap could be observed. No approach-related complications were found.     

A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures

Objectives

To present a case series of patients with posterior bicondylar tibial plateau fractures treated by direct exposure and buttress plate fixation through posterior inverted L-shaped approach.

Methods

Between August 2007 and July 2010, eight middle aged patients were identified to have posterior bicondylar tibial plateau fractures. All the eight patients underwent direct fracture exposure, reduction under visualization, and buttress plate fixation through posterior inverted L-shaped approach.

Results

All the cases were followed for an average of 28.1 months (24–36 months). All the cases had satisfactory reduction except one case, which had a 3-mm stepoff postoperatively. None of the complications such as infection, necrosis of the skin incision or the loosening and breakage of the internal fixator occurred. The average radiographic bony union time and full weightbearing time were 11.5 weeks (10–14 weeks), and 13.8 weeks (11–17 weeks) respectively. The average range of motion of the affected knee was from 3.6° to 127.8° at 1 year after the operation.

Conclusions

The posterior inverted L-shaped approach would not involve osteotomy, tendotomy or division of muscles, while allowing satisfied visualization of the entire posterior aspect of tibial plateau and appropriate placement of hardware. This approach is a safe and effective way for the treatment of posterior bicondylar tibial plateau fractures.     

The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system

Background

Fractures of the tibial plateau are seen frequently in orthopedic trauma units and traditionally classified based on two-dimension plain radiographs with the Schatzker Classification system, the most popular. This system focuses on fractures involving the medial and lateral plateau but does not comment on fractures that involve the posterior aspect of the tibial plateau. The purpose of this study was to investigate the incidence of posterior tibial plateau fracture and propose a new computed tomography (CT)-based three-column classification system to guide fracture treatment.

Methods

Between January 2008 and December 2009, 525 tibial plateau fractures admitted to a level 1 trauma center were retrospectively analyzed by four orthopedic trauma surgeons. Antero-posterior plain radiographs were used for Schatzker classification. CT imaging was used to further classify the fracture types with axial views dividing the plateau into three columns: a lateral, medial, and posterior. Posterior tibial plateau fracture (PTPF) was defined as a fracture with an independent fragment of the posterior column

Results

PTPFs were found in 151 cases and had an incidence of 28.8 % in this studied population. Except for type III, PTPFs were observed in each type of the Schatzker classification system. The Schatzker type VI, V, and IV fractures had the three highest percentages of PTPFs, with 76.1, 51.2, and 22.4 %, respectively.

Conclusions

Fractures of the posterior tibial plateau are not uncommon, especially in high-energy trauma. CT imaging is required to appreciate these fracture patterns, and a three-column classification allows for a better understanding of the fracture morphology and the injury mechanism, which guides surgical management.     

Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture

Introduction  

There are various surgical approaches for the treatment of posterior cruciate ligament (PCL) injury-associated tibial fracture avulsion, including arthroscopy-assisted surgery and open posterior surgery. However, none of these treatments are perfect. We have established a simple procedure with microendoscopy-assisted reduction and cannulated screw fixation for the treatment of this disease through a single mini-incision. In this study, we delineated the effects of this surgical approach for patients with PCL tibial avulsion fracture.     

Osteosynthese einer bikondylären Tibiakopffraktur in Bauchlage

Objective

The aim of the surgical treatment of intra-articular bicondylar tibial plateau fractures is the anatomical reconstruction and direct biomechanical optimal fixation of the fractured articular surface and the leg axis, taking the frequently associated soft tissue damage into account.

Indications

This article presents a cadaver model of a simulated complex bicondylar tibial plateau fracture 41C3 according to the AO classification with fracture involvement of all 10 segments and indications for surgery due to a posteromedial shearing fracture and lateral articular destruction with posterolaterocentral impaction.

Contraindications

Pronounced soft tissue damage with acute or incompletely healed infections in the area of the surgical approach.

Surgical technique

In the presented video of the operation, which is available online, the direct treatment of an intra-articular complex tibial plateau fracture from dorsal in a prone position is shown in detail: posterolateral ca. 13?cm long skin incision immediately above the fibular head with subsequent gentle preparation of the peroneal nerve at the medial border of the biceps femoris muscle. Retraction of the lateral head of the gastrocnemius muscle medially. Proximal detachment of the soleus muscle from the fibular head and retraction of the popliteus muscle medially. Horizontal capsule incision for fracture visualization. Opening of the lateral window ventral to the lateral collateral ligament. If necessary, osteotomy of the lateral femoral epicondyle for improved posterolaterocentral fracture visualization. Angular stable osteosynthetic fixation. Posteromedial approach medial to the medial gastrocnemius head. Retraction of the medial head of the gastrocnemius muscle laterally, horizontal capsular incision with sparing of the semimembranosus muscle medially and posterior cruciate ligaments laterally, fracture reduction, fixation with posteromedial support plate, image converter control, wound closure.

Follow-up

Postoperative cooling and elevation of the operated limb. Depending on the fracture 6–10 weeks partial loading of maximum 20?kg. Prior to full load bearing clinical radiological follow-up checks to determine the bony consolidation and material positioning.

Results

This is an established and safe delivery strategy for complex fracture patterns with dorsally running fractures. The risk of intraoperative malreduction is low. Postoperative reduction losses depend on fracture, operation and especially patient-specific characteristics.

     

Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture

Objective

The study was undertaken to evaluate the efficacy and safety of a posterolateral reversed L-shaped knee joint incision for treating the posterolateral tibial plateau fracture.

Methods

Knee specimens from eight fresh, frozen adult corpses were dissected bilaterally using a posterolateral reversed L-shaped approach. During the dissection, the exposure range was observed, and important parameters of anatomical structure were measured, including the parameters of common peroneal nerve (CPN) to ameliorate the incision and the distances between bifurcation of main vessels and the tibial articular surface to clear risk awareness.

Results

The posterolateral aspect of the tibial plateau from the proximal tibiofibular joint to the tibial insertion of the posterior cruciate ligament was exposed completely. There was no additional damage to other vital structures and no evidence of fibular osteotomy or posterolateral corner complex injury. The mean length of the exposed CPN was 56.48 mm. The CPN sloped at a mean angle of 14.7° toward the axis of the fibula. It surrounded the neck of the fibula an average of 42.18 mm from the joint line. The mean distance between the opening of the interosseous membrane and the joint line was 48.78 mm. The divergence of the fibular artery from the posterior tibial artery was on average 76.46 mm from articular surface.

Conclusions

This study confirmed that posterolateral reversed L-shaped approach could meet the requirements of anatomical reduction and buttress fixation for posterolateral tibial plateau fracture. Exposure of the CPN can be minimized or even avoided by modifying the skin incision. Care is needed to dissect distally and deep through the approach as vital vascular bifurcations are concentrated in this region. Placement of a posterior buttressing plate carries a high vascular risk when the plate is implanted beneath these vessels.     

Fibula head is a useful landmark to predict the location of posterior cruciate ligament footprint prior to total knee arthroplasty

Purpose

The hypothesis of our study is that a routine tibial cut during cruciate retaining TKA may result in a partial or a total removal of the PCL footprint. Therefore providing a reliable landmark is essential to estimate the probability of PCL damage with a tibial cut and to enable the surgeon to decide pre-operatively whether a cruciate retaining implant design is suitable.

Methods

In a case series of 175 cruciate retaining TKA, the routinely made standing postoperative AP-view radiographs were evaluated to determine the distance between fibula head and tibial cutting plane. In a second case series knee MRI of 223 subjects were consecutively used to measure the vertical distance between tibial attachment of PCL and fibula head. The probability of partial or total PCL damage was calculated for different vertical distances between tibial cut and fibula head.

Results

The vertical distance between the tibial cut and the most proximal point of the fibula head averaged 6.1 mm ±4.8 mm. The mean vertical distance from fibula head to proximal and to distal PCL footprint revealed to be 11.4 mm ±3.7 mm and 5.4 mm ±2.9 mm, respectively. The location of the insertion was not significantly different between subgroups such as age (<50 or >50 years), gender and side. Based on our results 11 (7 %) knees were considered at high risk of an entire PCL removal after implantation of a cruciate retaining TKA design.

Conclusions

Currently available routine tibial preparation techniques result in partial or total posterior cruciate ligament detachment. Fibula head as a landmark aids to predict the PCL location and to estimate its disruption pre- and postoperatively on AP-view radiographs.     

Tibiakopffrakturen im Wintersport

Background

Tibial plateau fractures overall and especially in winter sports are rare. However, the incidence in recent years is increasing. In a retrospective study from 2009–2012, we found 52 injuries affiliated with winter sports. Noticeable was the high rate of severe injury patterns. In 20 of the 52 cases, there were complete articular or bicondylar fractures (38?%). In 25 cases (48?%), fragment dislocation corresponding to the Moore classification was observed.

Methods

The operative algorithm was based on the initial soft tissue damage and the type of fracture. A two or more stage procedure with first line soft tissue management and temporary external fixation stabilization was performed 12 times. The final internal osteosynthesis was based on the morphology of the fracture, i.e., direct exposition and stabilization of relevant fracture patterns. In 24 cases (46?%), there was a need for two (or more) approaches. In the anterior aspect of the tibial head, customary implants were used; posterior pathologies were stabilized with low-dimension implants.

Results

Summarizing with regard to the literature, there is a more discriminating view of tibial plateau fractures, regarding all relevant fracture patterns. Thus, different options in operative access and choice of implants can be made.     

The biomechanical characteristics of arthroscopic tibial inlay techniques for posterior cruciate ligament reconstruction: in vitro comparison of tibial graft tunnel placement

Purpose

The hypothesis of the present study was that the biomechanical properties of arthroscopic tibial inlay procedures depend on tibial graft bone block position.

Methods

Five paired fresh-frozen human cadaveric knee specimens were randomized to a reconstruction with quadriceps tendon placing the replicated footprint either to the more proximal margin of the remnants of the anatomical PCL fibrous attachments (group A) or to the distal margin of the anatomical PCL fibrous attachments at the edge of the posterior tibial facet to the posterior tibial cortex in level with the previous physis line (group B). The relative graft-tibia motions, post cycling pull-out failure load and failure properties of the tibia-graft fixation were measured. Cyclic displacement at 5, 500 and 1,000 cycles, stiffness and yield strength were calculated.

Results

The cyclic displacement at 5, 500 and 1,000 cycles measured consistently more in group A without statistically significant difference (4.11?±?1.37, 7.73?±?2.73 and 8.18?±?2.75 mm versus 2.81?±?1.33, 6.01?±?2.37 and 6.46?±?2.37 mm). Mean ultimate load to failure (564.6?±?212.3) and yield strength (500.2?±?185.9 N) were significantly higher in group B (p?Conclusion Replicating the anatomical PCL footprint at the posterior edge of the posterior tibial facet yields higher pull-out strength and less cycling loading displacement compared to a tunnel position at the centre of the posterior tibial facet.     

Navigation of the tibial plateau alone appears to be sufficient in computer-assisted unicompartmental knee arthroplasty

Purpose

The aim of this study was to present our technique to implant unicompartmental knee arthroplasty (UKA) using navigation and to give our first results regarding the accuracy of the device.

Methods

A total of 33 patients with medial femorotibial osteoarthritis (31) or avascular necrosis (2) were included in this study. The mean preoperative hip-knee-ankle (HKA) angle was 172.7?±?2.2° (range 167?C177°) and the preoperative planning aimed to reach an HKA angle between 175 and 179° (177?±?2°), a tibial varus at 3?±?1°, which means a tibial mechanical angle (TMA) close to 87?±?1°, and posterior tibial slope at 3?±?2°. In all cases, we used the OrthoPilot? device with dedicated software allowing us to navigate only the tibial plateau.

Results

The preoperative plan was reached in 93.9?% of cases for HKA angle, 84.8?% for TMA and 100?% for the posterior slope.

Conclusions

Unicompartmental knee navigation is reliable. The navigation of only the tibial bone cut is a reasonable option as has been shown in this study. Its role is invaluable in the positioning of mobile-bearing UKA, where the risk of overcorrection should not be underestimated.     

Study protocol: trial of inflation osteoplasty in the management of tibial plateau fractures

Introduction

Restoration of articular congruency is a key factor in preventing post-traumatic osteoarthritis following tibial plateau fractures. Current surgical techniques using a bone tamp carry the risk of joint perforation and comminution of the depressed fragments which affect patient outcome. Successful use of inflation osteoplasty has been reported in both in vitro studies (Broome et al. in J Orthopaed Traumatol 13(2):89–95, 2012; Mauffrey et al. in Patient Saf Surg 6:6, 2012) and case reports in the management of fractures of the calcaneus, cuboid, distal radius, tibial plateau and acetabulum (Gupta et al. in Foot Ankle Int 32(2):205–210, 2011; Heim et al. in Foot Ankle Int 29(11):1154–1157, 2008; Konig et al. in Case Rep Unfallchirurg 109(4):328–331, 2006; Reiley in J Orthop Trauma 17:141–163, 2006). The aim of our study is to assess whether the use of the balloon osteoplasty improves the quality of reduction of a depressed tibial plateau fracture when compared to traditional methods of fracture reduction.

Method

This is a single-centred randomised trial. We will recruit 24 adult patients admitted with either a depressed or split depressed tibial plateau fracture (medial or lateral) requiring surgical intervention. Consenting patients will be randomly allocated to the two treatment groups. Patients with concomitant injuries influencing the management of the tibial plateau fracture will be excluded from our study. The primary outcome measure is the quality of reduction based on the post-operative CT scan. Secondary outcome measures will be any surgical complication and patient satisfaction, measured using the Oxford Knee score and SF12 questionnaire at 3, 6 and 12 months. Principal analysis will be for the success of fracture reduction from the two techniques and the effect the operative technique had on patient satisfaction and the prevalence of surgical complications.     

Surgical Treatment of Tibial Plateau Fractures

Objective

Closed reduction of Schatzker type 4, 5, and 6 fractures of the tibial plateau, internal fixation by lag screws inserted through a mini-incision, and stabilization with Ilizarov external ring fixator.

Indications

Fractures of the tibial plateau of Schatzker type 4, 5, and 6.

Contraindications

Open infected tibial plateau fractures. Relative contraindications are Schatzker type 1, 2, and 3 fractures of the tibial plateau which can be treated by simpler methods.

Surgical Technique

Reduction of fracture by longitudinal traction on a frature table. Percutaneous insertion of two or three 6.5-mm lag screws to compress the major fragments. Stabilization of the fracture with a three-ring construction of the Ilizarov frame. Further compression of fragments with olive wires, used also to reduce and compress posterolateral and/or posteromedial fragments. The frame is ex-tended to the femur in instances of subluxation of the knee joint, ligamentous injuries, and associated femoral condylar fractures.

Results

Between 1991–1997, 56 patients were operated on. Aver-age follow-up: 3 years. Union occurred in all. Six patients showed a varus deformity of 5–10° and one a varus deformity of 15° four patients had an extension lag between 5–10°. A minor pin tract infection was observed 20 times and a major pin tract infection three times necessitating pin removal. One patient who suffered a compound fracture complicated by aseptic arthritis eventually required an arthrodesis. Applying the score of the American Knee Society, an excellent result was obtained 20 times, a good result 28 times, a fair one four times, and a poor one four times.     

Management of high-energy tibial plateau fractures by Ilizarov external fixator

Background

Despite the evolution of surgical techniques and implants, high energy tibial plateau fractures remain a challenging problem. The goals of treatment are to obtain a well-aligned stable joint with a painless functional range of motion and prevention of posttraumatic arthritis. Indirect reduction techniques and other soft tissue preservation methods safeguard the vascularity and emphasize restoring both joint congruity and the mechanical axis of the limb. The aim of this study was to evaluate the clinical outcome of using Ilizarov external fixator in the treatment of Schatzker type V–VI tibial plateau fracture.

Methods

This study was done during the period 2009–2011 for the treatment of 30 patients with high energy tibial plateau fractures (Schatzker type V in 17 and type VI in 13 patients) by Ilizarov external fixator. The mean age was 36 years .There were 23 males. The right limb was affected in 17 patients. There were 10 open fractures and other associated injuries in 9 patients.

Results

The mean of follow up period was 18 months. All the fractures were united in an average time of 15 weeks. There were pin track infection in 20 patients and other few complications in 8 patients. According to knee society score, there was an excellent result in 16.7 %, good in 60 %, fair in 20 %, and poor in 3.3 %.

Conclusion

Ilizarov external fixation is a safe and effective treatment option for high energy tibial plateau fractures with good functional results.     

Arthroskopische Wiederherstellung einer Ausrissfraktur des hinteren Kreuzbands am Tibiaansatz

Avulsion fracture of the tibial insertion of the posterior cruciate ligament (PCL) is a rare condition. Until recently, bony avulsion fractures of the PCL have been repaired with open reduction and internal fixation. Posterior approach commonly used for open repair is rather extensive, yet it does not allow for detection and managment of associated intraarticular injuries of the knee. We report a case of avulsion fracture of the tibial attachment of the PCL managed by arthroscopic reduction and fixation. A large bony fragment that extended into the posterior part of the lateral tibial plateau allowed for reduction and retrograde fixation through anterior portals only.     

The Intact Posterior Cruciate Ligament Not Only Controls Posterior Displacement but Also Maintains the Flexion Gap

Background

The PCL is a strong stabilizer of the knee and provides posterior stability to the tibia. However, sagittal alignment of the PCL with the knee at 90° flexion suggests the PCL might play a role not only in posterior stabilization but also in maintaining the flexion gap.

Questions/purposes

We determined whether the intact PCL helps maintain the flexion gap.

Methods

We examined axial radiographs and gravity sag views of 17 patients with chronic isolated unilateral PCL injury. The flexion gap was defined as the mean value of the medial and lateral distances between the femoral and tibial bones on the axial radiograph. Increase in the flexion gap and posterior laxity were determined by comparing the patients’ injured and contralateral uninjured knees.

Results

The flexion gap of PCL injured knees (median, 7.5 mm; range, 5.3–11.5 mm; medial median, 6.2 mm; medial range, 3.7–8.3 mm; lateral median, 7.9 mm; lateral range, 5.3–11.5 mm) was larger than that seen in uninjured knees (median, 5.0 mm; range, 4.0–7.6 mm; medial median, 4.6 mm; medial range 3.4–7.1 mm; lateral median, 5.6; lateral range, 4.5–11.2 mm). The increment in the medial distance was similar to that in the lateral distance. Posterior laxity of injured knees was 9.1 (median); 5.4 to 15.2 (range) mm greater than that of uninjured knees. We found no correlation between posterior laxity and the flexion gap increment.

Conclusions

Our data suggest the intact PCL controls posterior displacement and maintains the flexion gap.     

Multi-plate reconstruction for severe bicondylar tibial plateau fractures of young adults

Purpose

This study was to evaluate clinical outcomes and complications following multi-plate reconstruction for treating severe bicondylar tibial plateau fractures of young adults.

Methods

Between September 2007 and February 2012, 26 patients with severe bicondylar tibial plateau fractures met inclusion criteria; they were treated using multi-plate technique through combined approaches. Patients received an average follow-up of 40.8 (range, 18–64) months, which included anteroposterior and lateral imaging, postoperative complications, range of motion and stability of the knee. The Rasmussen score was applied for functional and radiological evaluation.

Results

Three to five plates were used for reconstruction. No intra-operative complications occurred. Postoperative complications included bulge of hardware in four patients and superficial dehiscence in three cases in the anterolateral incision of which one developed to deep infection. There was no neurovascular damage, and no implant breakage or loosening. Hardware was removed partly or totally in 16 cases. The average Rasmussen score at final follow-up was 27.2 (range, 21–30) points for functional evaluation and 16.4 (range, 14–18) for radiology.

Conclusions

Multi-plate reconstruction is a valid and safe method for treating severe bicondylar tibial plateau fractures of young adults.