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This randomized clinical trial evaluated the impact of immediate weight-bearing as tolerated on spatiotemporal gait parameters and fall risk in patients undergoing postoperative rehabilitation for tibial plateau fractures. A total of 106 patients who had undergone open reduction and internal fixation (ORIF) for Schatzker I-IV tibial plateau fractures were recruited, with 39 meeting the inclusion criteria and 10 lost to follow-up. Patients were randomly assigned to a non-weight-bearing group (NWB), following a 6-week non-weight-bearing rehabilitation protocol, or a weight-bearing group (WB), allowed immediate weight-bearing. Both groups received the same therapeutic exercise program. Gait parameters were assessed three months post-surgery, including step length, stride length, single stance time, double stance time, step time, stride time, velocity, cadence, stride width, and gait and balance scores from Tinetti Performance Oriented Mobility Assessment (POMA). Of the 29 patients who completed the study, significant differences in favor of the WB group were observed for affected limb step length (p = 0.010), sound limb step length (p = 0.013), stride length (p = 0.010), affected single limb stance time (p = 0.001), sound single limb stance time (p = 0.007), velocity (p = 0.021), and POMA scores for balance (p = 0.021) and gait (p = 0.002). Immediate weight-bearing as tolerated after ORIF for Schatzker I-IV tibial plateau fractures resulted in improved spatiotemporal gait parameters and reduced fall risk.

In recent years, the trend in orthopedic and trauma surgery has shifted towards earlier mobilization with reduced weightbearing restrictions to enhance patient recovery. Tibial-shaft-spiral-fractures pose a challenge for early mobilization. This study examines the use of additive cerclages, which allow for immediate full-weightbearing, and compares it to the standard-of-care (SOC) treatment with partial-weightbearing. The primary aim was to evaluate mobility, return-to-daily-activities, and safety outcomes. This prospective multicenter study included 36 patients with tibial-shaft-spiral-fractures. Group1 ( n  = 20) received an additive cerclage and was permitted immediate full weightbearing-as-tolerated, while Group2 ( n  = 16) followed SOC with 20 kg partial weightbearing for 6 weeks. Gait analysis was performed at 1,3,6, and 12-weeks, as well as 6-months post-surgery, using the loadsol ® force-measuring device. Patient-reported outcomes, including pain levels, quality of life (EQ-5D), and return to daily activities, were assessed at these intervals. The results showed that immediate weightbearing as tolerated led to significantly faster mobilization. By week-3, 35% (7 of 20) of patients in Group1 were walking unassisted compared to 6.25% (1 of 16) in Group 2 ( p  = 0.04). By week 6, 75% (15 of 20) of patients in Group1 were walking without crutches, compared to 31.25% (5 of 16) in Group2 ( p  = 0.002). Gait speed and mobility were significantly improved in the cerclage group throughout the early postoperative period, with quality of life scores also higher during the early postoperative phase (gait speed week 3 2.57 ± 0.49 km/h vs. 2.16 ± 0.70 km/h, p  = 0.032; EQ-5D week 1 3.59 ± 0.85 vs. 3.05 ± 0.56, p  = 0.017). No significant differences in complications were observed between the groups. The use of additive cerclages for tibial-shaft-spiral-fractures is a safe and effective method that allows for immediate full-weightbearing, resulting in earlier mobilization and improved short-term quality of life. Trail registration number: DRKS00035464 ( www.drks.de ), Date of registration: 17/12/2024.

Purpose Although the mechanisms of injury are similar to ACL rupture in adults, publications dealing with meniscal lesions resulting from fractures of the intercondylar eminence in children are much rarer. The main objective was to measure the frequency of meniscal lesions associated with tibial eminence fractures in children. The second question was to determine whether there is any available evidence on association between meniscal tears diagnostic method, and frequencies of total lesions, total meniscal lesions, and total entrapments. Methods A comprehensive literature search was performed using PubMed and Scopus. Articles were eligible for inclusion if they reported data on intercondylar tibial fracture, or tibial spine fracture, or tibial eminence fracture, or intercondylar eminence fracture. Article selection was performed in accordance with the PRISMA guidelines. Results In total, 789 studies were identified by the literature search. At the end of the process, 26 studies were included in the final review. This systematic review identified 18.1% rate of meniscal tears and 20.1% rate of meniscal or IML entrapments during intercondylar eminence fractures. Proportion of total entrapments was significantly different between groups (17.8% in the arthroscopy group vs. 6.2% in the MRI group; p  < .0001). Also, we found 20.9% of total associated lesions in the arthroscopy group vs. 26.1% in the MRI group ( p  = .06). Conclusion Although incidence of meniscal injuries in children tibial eminence fractures is lower than that in adults ACL rupture, pediatric meniscal tears and entrapments need to be systematically searched. MRI does not appear to provide additional information about the entrapment risk if arthroscopy treatment is performed. However, pretreatment MRI provides important informations about concomitant injuries, such as meniscal tears, and should be mandatory if orthopaedic treatment is retained. MRI modalities have yet to be specified to improve the diagnosis of soft tissues entrapments. Study design Systematic review of the literature Registration PROSPERO N° CRD42021258384

Does low intensity pulsed ultrasound (LIPUS) accelerate recovery in adults and children who have experienced bone fractures or osteotomy (cutting of a bone)? An expert panel rapidly produced these recommendations based on a linked systematic review triggered by a large multicentre randomised trial in adults with tibial fracture.

Purpose To compare the clinical, radiological outcomes, economic and technical differences for ORIF by cancellous screw fixation versus ARIF by double-tunnel suture fixation for displaced tibial-side PCL avulsion fractures. Methods Forty patients with displaced tibial-sided PCL avulsions were operated upon after randomizing them into two groups (20 patients each in the open and arthroscopic group) and followed up prospectively. Assessment included duration of surgery, cost involved, pre- and post-operative functional scores, radiological assessment of union, and posterior laxity using stress radiography and complications. Results The mean follow-up period was 33 months (27–42) (open group) and 30 months (26–44) (arthroscopic group). The duration of surgery was significantly larger in the arthroscopic group (47.8 ± 17.9 min) as compared to the open group (33.4 ± 10.1 min). The costs involved were significantly higher in the arthroscopic group ( p − 0.01). At final follow-up, knee function in the form of IKDC (International Knee Documentation Committee) evaluation (89.9 ± 4.8-open and 89.3 ± 5.9-arthroscopic) and Lysholm scores (94.2 ± 4.1-open and 94.6 ± 4.1-arthroscopic) had improved significantly with the difference (n.s.) between the two groups. The mean posterior tibial displacement was 5.7 ± 1.8 mm in the open group and 6.3 ± 3.1 mm in the arthroscopic group which was (n.s.). There were two non-unions and one popliteal artery injury in the arthroscopic group. Conclusion Both ARIF and ORIF for PCL avulsion fractures yield good clinical and radiological outcomes. However, ORIF was better than ARIF in terms of cost, duration of surgery, and complications like non-union and iatrogenic vascular injury. Level of evidence II.

Objective To determine whether low intensity pulsed ultrasound (LIPUS), compared with sham treatment, accelerates functional recovery and radiographic healing in patients with operatively managed tibial fractures.Design A concealed, randomized, blinded, sham controlled clinical trial with a parallel group design of 501 patients, enrolled between October 2008 and September 2012, and followed for one year.Setting 43 North American academic trauma centers.Participants Skeletally mature men or women with an open or closed tibial fracture amenable to intramedullary nail fixation. Exclusions comprised pilon fractures, tibial shaft fractures that extended into the joint and required reduction, pathological fractures, bilateral tibial fractures, segmental fractures, spiral fractures >7.5 cm in length, concomitant injuries that were likely to impair function for at least as long as the patient’s tibial fracture, and tibial fractures that showed <25% cortical contact and >1 cm gap after surgical fixation. 3105 consecutive patients who underwent intramedullary nailing for tibial fracture were assessed, 599 were eligible and 501 provided informed consent and were enrolled.Interventions Patients were allocated centrally to self administer daily LIPUS (n=250) or use a sham device (n=251) until their tibial fracture showed radiographic healing or until one year after intramedullary fixation.Main outcome measures Primary registry specified outcome was time to radiographic healing within one year of fixation; secondary outcome was rate of non-union. Additional protocol specified outcomes included short form-36 (SF-36) physical component summary (PCS) scores, return to work, return to household activities, return to ≥80% of function before injury, return to leisure activities, time to full weight bearing, scores on the health utilities index (mark 3), and adverse events related to the device.Results SF-36 PCS data were acquired from 481/501 (96%) patients, for whom we had 2303/2886 (80%) observations, and radiographic healing data were acquired from 482/501 (96%) patients, of whom 82 were censored. Results showed no impact on SF-36 PCS scores between LIPUS and control groups (mean difference 0.55, 95% confidence interval −0.75 to 1.84; P=0.41) or for the interaction between time and treatment (P=0.30); minimal important difference is 3-5 points) or in other functional measures. There was also no difference in time to radiographic healing (hazard ratio 1.07, 95% confidence interval 0.86 to 1.34; P=0.55). There were no differences in safety outcomes between treatment groups. Patient compliance was moderate; 73% of patients administered ≥50% of all recommended treatments.Conclusions Postoperative use of LIPUS after tibial fracture fixation does not accelerate radiographic healing and fails to improve functional recovery.Study registration ClinicalTrialGov Identifier: NCT00667849

Introduction Preoperative planning is a critical step in the success of any complex surgery. The pur-pose of this study is to evaluate the advantage of VR glasses in surgical planning of complex tibial plateau fractures compared to CT planning. Materials and methods Five orthopedic surgeons performed preoperative planning for 30 fractures using either conventional CT slices or VR visualization with a VR headset. Planning was performed in a randomized order with a 3-month interval between planning sessions. A standardized questionnaire assessed planned operative time, planning time, fracture classification and understanding, and surgeons’ subjective confidence in surgical planning. Results The mean planned operative time of 156 (SD 47) minutes was significantly lower ( p  < 0.001) in the VR group than in the CT group (172 min; SD 44). The mean planning time in the VR group was 3.48 min (SD 2.4), 17% longer than in the CT group (2.98 min, SD 1.9; p  = 0.027). Relevant parameters influencing planning time were surgeon experience (-0.61 min) and estimated complexity of fracture treatment (+ 0.65 min). Conclusion The use of virtual reality for surgical planning of complex tibial plateau fractures resulted in significantly shorter planned operative time, while planning time was longer compared to CT planning. After VR planning, more surgeons felt (very) well prepared for surgery.

The aim of this study was to compare the clinical outcomes, biomechanical performance, and cost-effectiveness of finite element planning (FEP) with those of traditional (Trad) methods in the treatment of complex tibial plateau fractures in middle-aged and elderly patients to ultimately optimize treatment protocols, improve surgical efficiency, and reduce the economic burden on patients. Sixteen patients with complex tibial plateau fractures were randomly divided into FEP and Trad groups, with eight patients in each group. The FEP group underwent preoperative finite element analysis for personalized surgical planning and dual-plate fixation; the Trad group participated in traditional preoperative discussions and underwent a multi-plate fixation. Perioperative and postoperative indicators were collected from both groups, and the stress distribution and displacement under different internal fixation modes were evaluated using finite element analysis. Additionally, a cost-effectiveness analysis was conducted to compare the total costs of internal fixation and hospitalization. The surgical times were significantly shorter in the FEP group than in the Trad group (170.00 ± 59.52 vs. 240.00 ± 59.04 min, p  = 0.033), and patients in the Trad group had shorter times to ambulation (12.88 ± 0.99 vs. 14.25 ± 1.49 days, p  = 0.047). There were no significant differences between the groups in terms of postoperative orthopaedic scores, mobility indices, fracture healing times, or radiological indicators. Biomechanical analysis revealed that the multiplate fixation mode provided a more uniform stress distribution, but this difference was not statistically significant. In the FEP group, the total costs of internal fixation (4772.25 ± 217.31 vs. 8991.88 ± 2811.25 yuan, p  = 0.004) and hospitalization (34796.75 ± 9749.19 vs. 65405.14 ± 28684.80 yuan, p  = 0.013) were significantly lower. While ensuring clinical effectiveness, FEP demonstrated greater cost-effectiveness by shortening the surgery time and reducing internal fixation costs. Although the multiplate fixation mode was biomechanically superior to the dual-plate mode, it did not result in significant clinical advantages and was more costly. FEP improves the economic efficiency of treatment for complex tibial plateau fractures in middle-aged and elderly patients and is recommended. This study has certain limitations, such as a small sample size and a short follow-up period. Thus, larger-scale studies with longer-term follow-up data are needed to further validate these findings and explore whether all patient populations can benefit from these practices or if the benefits are limited to specific groups, such as elderly patients or those with certain types of fractures.

Background Treatment of non-union remains challenging and often necessitates augmentation of the resulting defect with an autologous bone graft (ABG). ABG is limited in quantity and its harvesting incurs an additional surgical intervention leaving the risk for associated complications and morbidities. Therefore, artificial bone graft substitutes that might replace autologous bone are needed. S53P4-type bioactive glass (BaG) is a promising material which might be used as bone graft substitute due to its osteostimulative, conductive and antimicrobial properties. In this study, we plan to examine the clinical effectiveness of BaG as a bone graft substitute in Masquelet therapy in comparison with present standard Masquelet therapy using an ABG with tricalciumphosphate to fill the bone defect. Methods/design This randomized controlled, clinical non-inferiority trial will be carried out at the Department of Orthopedics and Traumatology at Heidelberg University. Patients who suffer from tibial or femoral non-unions with a segmental bone defect of 2–5 cm and who are receiving Masquelet treatment will be included in the study. The resulting bone defect will either be filled with autologous bone and tricalciumphosphate (control group, N  = 25) or BaG (S53P4) (study group, N  = 25). Subsequent to operative therapy, all patients will receive the same standardized follow-up procedures. The primary endpoint of the study is union achieved 1year after surgery. Discussion The results from the current study will help evaluate the clinical effectiveness of this promising biomaterial in non-union therapy. In addition, this randomized trial will help to identify potential benefits and limitations regarding the use of BaG in Masquelet therapy. Data from the study will increase the knowledge about BaG as a bone graft substitute as well as identify patients possibly benefiting from Masquelet therapy using BaG and those who are more likely to fail, thereby improving the quality of non-union treatment. Trial registration German Clinical Trials Register (DRKS), ID: DRKS00013882 . Registered on 22 January 2018.

Tibial plateau fractures, accounting for approximately 1% of adult fractures, are often associated with significant long-term complications such as pain, stiffness, and posttraumatic arthrosis. The optimal treatment approach remains controversial, particularly in resource-limited settings. This study investigated the factors influencing the clinical outcomes of patients with tibial plateau fractures in Ethiopia. Tibial plateau fractures, though common in trauma cases, have been poorly studied in sub-Saharan Africa, particularly in Ethiopia. The primary purpose of this study was to examine the factors influencing the clinical outcomes of patients with tibial plateau fractures and to assess the efficacy of conservative treatment versus surgical intervention. This research aims to provide insights into managing tibial plateau fractures in resource-limited settings, with the hope of contributing to improved clinical practices. A total of 191 patients with tibial plateau fractures were recruited from Tibebe Ghion Referral Hospital and Felegehiwot Specialized Hospital between February 1, 2018, and February 2022. Demographic, clinical, and radiological data were analyzed, and treatment outcomes were assessed via Rasmussen's knee functional outcome score. A correlation analysis was performed to identify factors impacting functional outcomes. Logistic regression was used to identify factors influencing clinical outcomes. The study population was predominantly male (73.8%), with a mean age of 45 years. Road traffic accidents (41.9%) were the most common cause of injury. Schatzker type I fractures (27.2%) were the most common, and compound fractures accounted for 21% of the fractures. The average time to definitive management was 1.59 weeks, with 35% of patients undergoing open reduction and internal fixation (ORIF). The duration of immobilization and weight-bearing significantly influenced functional outcomes. Patients who were immobilized for less than 4 weeks had better outcomes, with functional scores 54 times better than those of patients who were immobilized for more than 8 weeks (p < 0.01). Early initiation of partial weight-bearing also improved outcomes. A strong negative relationship was found between the duration of immobilization and functional outcomes (r = -0.705, p < 0.01). This study highlights the importance of early mobilization and optimal management of tibial plateau fractures for improving functional outcomes. Timely treatment, especially regarding immobilization and weight-bearing, is crucial for achieving better results. These findings emphasize the need for more standardized treatment protocols and further research on tibial plateau fractures in sub-Saharan Africa to increase patient care in resource-limited settings.