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Surgery and Anesthesia 2018 & Euro Gastro Congress 2018
Case Reports in Surgery and Invasive Procedures
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Volume 2
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GASTROENTEROLOGY
3
rd
International Conference on
SURGERY AND ANESTHESIA
International Conference on
Abdul Qadir, Case Rep Surg Invasive Proced 2018, Volume 2
COMPLICATED TIBIAL PLATEAU
FRACTURES IN YOUNG PATIENTS:
FUNCTIONAL OUTCOME WITH DUAL
PLATING VIA A2 INCISION TECHNIQUE
EXPERIENCE OF TWO PUBLIC SECTOR
HOSPITALS OF KARACHI, PAKISTAN
Abdul Qadir
Civil Hospital Karachi, Pakistan
M
otorbike accidents contribute one of the most important factors of tibi-
al plateau fracture among young populations in Karachi Pakistan. Most
surgeons feel challenging to treatment complicated bi-condylar fractures of
the tibial plateau. This prospective study was designed to evaluate the func-
tional outcomes of dual plating via A2 incisions technique for the fixation of
complicated bi-condylar tibial plateau fractures in young patients in Karachi
Pakistan.
Method:
This prospective study include 94 cases of Type V and VI tibial pla-
teau fractures of young patients operated between January 2014 and Dec
2016 conducted in two public sector hospital of Karachi Pakistan. Exclusion
criteria include patients with multiple fracture on same side or same bone,
age more than 45 years, open contaminated fracture and patients with head
injuries. All cases were operated either by lateral locking plate fixation by an-
terolateral approach or double plating through double incision. All cases were
followed for a minimum of 24 months radiologically and clinically. The statis-
tical analysis was performed using software SPSS 20.0 to analyze the data.
Results:
A total of 94 patients (45 Single Plating and 49 Dual Plating) were
operated during the study period of two years. However, four patients (four
single plating and zero dual plating) were lost during follow up who could not
be tracked. Both groups were somewhat similar in relation to the age, mecha-
nism of injury, fracture pattern and soft tissue injury. Preoperatively, there was
a significant increase in surgical time with the dual plating group; however,
the mean time of reduction between the two groups was not significant. Deci-
sion to put bone graft was at the choice of the operating surgeon and was an
intraoperative decision with 74 (78.7%) patients receiving bone graft. Postop-
eratively, there was no immediate difference in between the groups consider-
ing the malignant and reduction. It took approximately four to five months for
the fractures to get united. The was no malunion, nonunion or implant failure
seen among those patients. There were 10 cases with superficial infection in
wounds of dual plating group which were treated with culture sensitive antibi-
otics for average two weeks, healed subsequently. There were three patients
found having incidence of deep infection in a double plating group, where in
two patients were positive with
Staphylococcus aureus
and one patient with
Abdul Qadir is a Surgeon specializing in orthopedic sur-
gery with an emphasis on advanced techniques in this
field disciplined and confident doctor with Saudi Arab
license and board certification in surgery. More than 04
years of experience in hospital and clinical settings.
capricorncious1@hotmail.comBIOGRAPHY
E.coli
was isolated. Extensive wound irrigation
and lavage with antibiotic cement beads was
given. Repeated irrigation and lavage was done
again after two weeks with removal of beads fol-
lowed by prolonged course of antibiotic therapy
for six weeks after which the infection resolved.
A total of 38 (77%) patients in a double plating
group regained full flexion (135°) and full exten-
sion (0°) with a good alignment and no pain and
instability as compared to single plating group,
seen in 30 (66%) patients at follow-up.
Conclusion:
Dual plating by two incision method
resulted in better functional outcome regarding
limb alignment and range of movements at knee
joint with an acceptable soft tissue complication
rate in young patients.