Description
Introduction: Shatzker II and III tibial plateau fractures require anatomic reduction of the articular surface. Recently, the use of the Tibioplasty technique is becoming more widespread, which thanks to the controlled pressure inflated balloon (normally used for kyphoplasty) is able to evenly distribute the reduction force over a larger bone surface. With arthroscopic assistance, it is a minimally invasive technique that allows an excellent radiological and functional result.
Materials and Methods: In the last 2 years we treated 8 patients with an average age of 32 years with the arthroscopically assisted tibioplasty technique. After reduction, the bone gap was filled with bone substitutes (calcium phosphate) and stabilised with 5.0-mm cannulated screws. The patients were evaluated clinically at outpatient clinical and radiographic follow-ups at 1,2,3,6,12 months after surgery. At the last follow-up an MRI of the knee was performed and rating scales administered.
Results: All patients achieved complete bone healing and were able to fully load on the operated limb within an average time of 45 days after surgery. Short- and medium-term complications were not recorded. The Tegner Activity Scale at 12 months is comparable to the pre-injury. The other assessment scales (VAS, KOOS, Cincinnati, Tegner, IKDC) showed good/excellent results. The conversion rate to open technique was 5%.
Discussion: the technique is not always feasible. An alternative plan should always be considered and the patient informed first. The main problems in the unsuccessful execution of the technique lie in the impossibility of reduction due to local bone embedding.
Conclusion: In Shatzker II and III tibial plateau fractures, the arthroscopically assisted tibioplasty (ARIF) technique allows an excellent evaluation of the reduction achieved and the synthesis leads to bone healing with early loading due to locally inserted bone substitutes. A joint evaluation and the collaboration between a trauma and an arthroscopic specialist is essential for the evaluation of the case and the best intraoperative management. It is essential to assess the morphology of the fracture and whether it can be approached with this technique or with the classic curved beating technique.
