• Matthias Krause, Achim Preiss, Norbert M Meenen, Jürgen Madert, and Karl-Heinz Frosch.
• Departments of *Trauma and Reconstructive Surgery, and †Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany.
• J Orthop Trauma. 2016 Aug 1; 30 (8): 437-44.

ObjectiveTo analyze the anatomic accuracy of fracture reduction controlled by fluoroscopy as compared with arthroscopically assisted reduction ("fracturoscopy") in patients with complex tibial plateau fractures (AO/OTA 41-C). Quality of fracturoscopy-guided reduction was checked with postoperative computed tomography.DesignProspective observational study.SettingUrban level 1 trauma center.PatientsSeventeen consecutive patients, with a complex, bicondylar tibial plateau fracture.InterventionThe intraoperative, open insertion of an arthroscope (2.4-mm or 2.8-mm optics), to visualize the articular surface and fracture reduction.Main Outcome MeasurementsAbility to detect residual fracture depression or gap after previous open reduction under fluoroscopic guidance.ResultsAn open fracture reduction with fluoroscopic guidance was performed in all cases. In 7 cases, open reduction and fluoroscopy resulted in satisfactory fracture reduction (fluoroscopy group). In 10 of 17 cases, subsequent "fracturoscopy" showed persistent fracture depression (≥2 mm, fracturoscopy group) with the need for intraoperative correction. Patients in the fracturoscopy group demonstrated significantly greater preoperative fragment depression (12.55 ± 6.56 mm) and a larger preoperative fracture gap (7.83 ± 5.49 mm) compared with patients with a satisfactory reduction under fluoroscopy (depression 4.97 ± 4.02 mm, P = 0.016; gap 2.47 ± 1.07 mm, P = 0.023). Fluoroscopy was not successful in achieving satisfactory reduction in cases in which the postero-latero-central region was affected (P = 0.004, χ test). Postoperative computed tomography demonstrated satisfactory articular reconstruction in all cases.ConclusionsIntraoperative fracturoscopy permitted a significantly improved visualization of fracture fragment displacement, specifically in the postero-latero-central region of the tibial plateau, as compared with fluoroscopy. Fracturoscopy is recommended for fractures involving the postero-latero-central region of the tibial plateau.Level Of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

23 keywords...

hide…