Evaluación artroscópica, lesiones de tejidos blandos en fracturas meseta tibial.

«Evaluación artroscópica de lesiones de tejidos blandos en fracturas de meseta tibial: Análisis restrospectivo de 98 casos.»

Mohamed Zaki Abdel-Hamid M.D.a, b, , , Chung-Hsun Chang M.D.a, Yi-Sheng Chan M.D.a, Yang-Pin Lo M.D.a, Jau-Wen Huang M.D.c, Kuo-Yao Hsu M.D.a and Ching-Jen Wang M.D.a

aDepartment of Orthopaedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan bEl-Kenayat Central Hospital, Sharkia, Egypt cDepartment of Orthopaedic Surgery, Division of Traumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

Purpose: This investigation arthroscopically assesses the frequency of soft tissue injury in tibial plateau fracture according to the severity of fracture patterns. We hypothesized that use of arthroscopy to evaluate soft tissue injury in tibial plateau fractures would reveal a greater number of associated injuries than have previously been reported.

Methods: From March 1996 to December 2003, 98 patients with closed tibial plateau fractures were treated with arthroscopically assisted reduction and osteosynthesis, with precise diagnosis and management of associated soft tissue injuries. Arthroscopic findings for associated soft tissue injuries were recorded, and the relationship between fracture type and soft tissue injury was then analyzed.

Results: The frequency of associated soft tissue injury in this series was 71% (70 of 98). The menisci were injured in 57% of subjects (56 in 98), the anterior cruciate ligament (ACL) in 25% (24 of 98), the posterior cruciate ligament (PCL) in 5% (5 of 98), the lateral collateral ligament (LCL) in 3% (3 of 98), the medial collateral ligament (MCL) in 3% (3 of 98), and the peroneal nerve in 1% (1 of 98); none of the 98 patients exhibited injury to the arteries. No significant association was noted between fracture type and incidence of meniscus, PCL, LCL, MCL, artery, and nerve injury. However, significantly higher injury rates for the ACL were observed in type IV and VI fractures.

Conclusions: Soft tissue injury was associated with all types of tibial plateau fracture. Menisci (peripheral tear) and ACL (bony avulsion) were the most commonly injured sites. A variety of soft tissue injuries are common with tibial plateau fracture; these can be diagnosed with the use of an arthroscope.

Arthroscopy: The Journal of Arthroscopic & Related Surgery Volume 22, Issue 6 , June 2006, Pages 669-675.

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