Surgical approach with percutaneous indirect articular reduction by elevating,minimal osteosynthesis and the use of NORIAN Skeletal Repair System lets us reach three fundamental objectives stated before. NORIAN S.R.S, used to fill the bone gap resulting from the traumatic collapse of the metaphyseal bone, with its mechanical strength allows the stabilization of the joint fragments, the reduction and the relative ostheosyntesis, thus greatly shortening the functional recovery time.
The minimum follow-up was 1 year. We used for clinical evaluation the Hohl assessment form, for the radiographs the criteria of Rasmussen.
Mobilization is allowed the day after surgery and weight-bearing within the first week in B2 e B3 fracture type and within four weeks in C3 type reducing to the minimum knee posthraumatic stiffness.
The choice of the treatment of tibial plateau fractures remains a controversial topic in current traumatology practice. The best treatment must have three fundamental requirements: to be less invasive as possible, to result in a good reduction, to have a good stability. Surgical approach with percutaneous indirect articular reduction by elevating,minimal osteosynthesis and the use of NORIAN Skeletal Repair System lets us reach three fundamental objectives stated before. NORIAN S.R.S, used to fill the bone gap resulting from the traumatic collapse of the metaphyseal bone, with its mechanical strength allows the stabilization of the joint fragments, the reduction and the relative ostheosyntesis, thus greatly shortening the functional recovery time. We reviewed 70 patients affected by tibial plateau fractures, treated with this percutaneous technique using the mineral bone substitute Norian: 56 fractures were unicondylar, 21 type 41-B2 and 35 type 41-B3 (according to AO/OTA classificaction); 14 fractures were bicondylar (AO/OTA 41-C3). The minimum follow-up was 1 year. We used for clinical evaluation the Hohl assessment form, for the radiographs the criteria of Rasmussen. X-rays. The final conclusions, resulting from integrated analysis of the clinical data and X-ray data, can be simplified and represented as follows: 52 cases could be considered excellent-good (74%), 14 fair (20%), and 4 poor (6%). We can claim that the recostruction of the tibial plateau by minimal invasive surgery such as the percutaneous indirect reduction by elevating minimal osteosyintesis and mechanical stability assured by NORIAN SRS, is a good improvement in order to cutdown the functional recovery time. Mobilization is allowed the day after surgery and weight-bearing within the first week in B2 e B3 fracture type and within four weeks in C3 type reducing to the minimum knee posthraumatic stiffness.
The treatment of the complex tibial plateau fractures is often hard because in these fractures, the entity of the articular damage is always important, the reduction is not easy it entails often extensive exposure and the collapse of the metaphyseal bone, located beneath the reconstructed articular surface, makes the osteosynthesis mechanically unsafe for ten or twelve weeks. The percutaneus surgical treatment, let us reach three fundamental objectives: to be mini-invasive, to result in a good reduction, to have a stable fixation. Through a small skin incision at the metaphysis, a leever was inserted across a small door made on the cortical metaphiseal bone and the articular fragments were elevated and held in the reduced position. Temporarily the fragments were fixed with a Kirshner-wire and definitely fixed with one or more canulated screw NORIAN S.R.S, used to fill the bone gap resulted from the traumatic collapse of the metaphyseal bone, with its initial mechanical strenghth allows to stabilize the joint fragments reduction and the relative ostheosyntesis, thus shortening the functional recovery time. Since 1997 we operated 52 patients affected by tibial plateau fractures using this percutaneus technique with the application of the mineral bone substitute Norian. 42 fractures were unicondylar: 16 type B2 and 26 Type B3 according to AO classificaction; 10 fractures were bicondylar 4 type C2 and 6 type C3 AO classificaction. The minimum follow-up was 1 year. We used for clinical evaluation the Hohl assessment form, for the radiographs the criteria of Rasmussen X-rays. The final conclusions, resulting from integrated analysis of the clinical data and X-rays data, can be simplified and represented as follows: 26 cases can be considered excellent that is (50%), 12 good (23%), 10 fair (20%), and 4 poor (7%). In conclusion we can say that Norian offers a real advantage in displaced tibial plateau fractures, because it is an unlimited supply of bone substitute, an optimal filling for the irregular defects of the cancellous bone and because it gives an immediate mechanical support to the joint, integrating the percutaneous ostheosynthesis perfectly. It is an important improvement in order to cut down the functional recovery time with great benefit for patients.
The treatment of complex tibial plateau fractures is often difficult because in these fractures the nature of the articular damage is always important, the reduction is not easy, often entailing extensive exposure, and the collapse of the metaphyseal bone, located beneath the reconstructed articular surface, makes the osteosynthesis mechanically unsafe for 10 or 12 weeks. There are three fundamental objectives of percutaneous surgical treatment: to be minimally invasive, to result in a good reduction and to achieve stable fixation. Through a small skin incision at the metaphysis, a leever was inserted across a small door made on the cortical metaphyseal bone and the articular fragments were elevated and held in the reduced position. Temporarily the fragments were fixed with a Kirschner wire and definitely fixed with one or more cannulated screws. Norian S.R.S was used to fill the bone gap that resulted from the traumatic collapse of the metaphyseal bone: with its initial mechanical strength the joint fragment reduction and the developing ostheosynthesis can be stabilised, thus shortening the functional recovery time. Between 1997 and 2002 we operated 52 patients with tibial plateau fractures using this percutaneous technique and application of the mineral bone substitute Norian. Of these, 42 fractures were unicondylar, 16 type B2 and 26 Type B3 according to the AO classification, and 10 fractures bicondylar 4 type C2 and 6 type C3 according to the AO classification. The minimum follow-up was 1 year. For clinical evaluation we used the Hohl assessment form, for the radiographs the criteria of Rasmussen X-rays. The final conclusions, resulting from integrated analysis of the clinical data and X-ray data, can be simplified and represented as follows: 26 cases can be considered excellent (50%), 12 good (23%), 11 fair (21 %) and three poor (6%). In conclusion, Norian offers a real advantage in the treatment of displaced tibial plateau fractures, because it offers an unlimited supply of bone substitute, is an optimal filling for the irregular defects of the cancellous bone and gives immediate mechanical support to the joint, integrating the ostheosynthesis perfectly. The recostruction of the tibial plateau with minimally invasive surgery such as percutaneous indirect reduction by elevation and percutaneous osteosynthesis, with mechanical stability assured by Norian SRS, is an important improvement. The functional recovery time is reduced, with great benefit for patients.
