Abstract:
Background: Intra-articular fractures of the proximal tibia can often be troublesome because of the early and late arthritic complications of damage of the articular surface, and intra-articular lesions. There are some potential benefits of arthroscopy in solving some of the pitfalls of these fractures. The purpose of this work is to study these benefits of arthroscopy in treatment of those patients, and the benefits of adding an anti-glide screw.
Patients and methods: Fifty patients with tibial plateau fractures were treated in Assiut University Hospitals. Of these patients only 16 were included in this study. Fourteen were men and 2 women. The age ranged between 27 and 60 years (mean 43 years). The inclusion criteria were patients with split, split depression, or local depression uni-condylar fractures according to Schatzker classification. The mean follow up was 15 months (6-24 months). The postoperative clinical evaluation depended up on Rasmussen scoring system. The radiological evaluation was according to Honkonen and Jarvinen.
Results: Complete anatomical reduction of the fragments was achieved in 14 knees (87.5%). Up to 2 mm displacement or step off was accepted in two knees (12.5%). Clinical assessment according to Rasmussen classification was: 10 knees (62.5%) excellent, 4 knees (25%) good, 2 knees (12.5%) fair, and none was poor. Radiological results were: 13 (81.25%) grade one, 2 knees (12.5%) grade two, and one knee (6.25%) grade three. None of the cases were grade four at the final follow up radiographs.
Conclusions: The use of arthroscopy allowed precise anatomic reduction of the articular surface of the knee joint. It is particularly helpful in type two and three injuries with central articular depression which are often difficult to assess on preoperative imaging studies. It is also helpful in assessing other intra-articular injuries and their management if possible. The anti-glide screw may help in prevention of loss of reduction.