Arthroscopic-assisted balloon tibioplasty versus open reduction internal fixation (ORIF) for treatment of Schatzker II-IV tibial plateau fractures: study protocol of a randomised controlled trial

Ji-Qi Wang, Bing-Jie Jiang, Wei-Jun Guo, Wei-Jiang Zhang, A-Bing Li, You-Ming Zhao, Ji-Qi Wang, Bing-Jie Jiang, Wei-Jun Guo, Wei-Jiang Zhang, A-Bing Li, You-Ming Zhao

Abstract

Introduction: Arthroscopic-assisted balloon tibioplasty is an emerging technology that has shown advantages in recovering depression of the articular surface. However, studies evaluating clinical outcomes between arthroscopic-assisted balloon tibioplasty and traditional open reduction internal fixation (ORIF) are sparse. This is the first randomised study to compare arthroscopic-assisted balloon tibioplasty with ORIF, and will provide guidance for treating patients with Schatzker types II, III and IV with depression of the medial tibial plateau only.

Methods and analysis: A blinded randomised controlled trial will be conducted and a total of 80 participants will be randomly divided into either the arthroscopic-assisted balloon tibioplasty group or the ORIF group, at a ratio of 1:1. The primary clinical outcome measures are the knee functional scores, Rasmussen radiological evaluation scores and the quality of reduction based on postoperative CT scan. Secondary clinical outcome measures are intraoperative blood loss, surgical duration, visual analogue scale score after surgery, hospital duration after surgery, complications and 36-Item Short-Form Health Survey score.

Ethics and dissemination: This study has been reviewed and approved by the Institutional Review Board of the Second Affiliated Hospital of Wenzhou Medical University (batch: 2017-12). The results will be presented in peer-reviewed journals after completion of the study.

Trial registration number: NCT03327337, Pre-results.

Keywords: adult orthopaedics; knee.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow chart showing the steps in participant recruitment, treatment and analysis. Balloon tibioplasty, arthroscopic-assisted balloon tibioplasty group; ORIF, open reduction and internal fixation group.

References

    1. McNamara IR, Smith TO, Shepherd KL, et al. . Surgical fixation methods for tibial plateau fractures. Cochrane Database Syst Rev 2015;240:Cd009679 10.1002/14651858.CD009679.pub2
    1. Mayr R, Attal R, Zwierzina M, et al. . Effect of additional fixation in tibial plateau impression fractures treated with balloon reduction and cement augmentation. Clin Biomech 2015;30:847–51. 10.1016/j.clinbiomech.2015.05.016
    1. Honkonen SE. Indications for surgical treatment of tibial condyle fractures. Clin Orthop Relat Res 1994;302:199–205. 10.1097/00003086-199405000-00031
    1. Maripuri SN, Rao P, Manoj-Thomas A, et al. . The classification systems for tibial plateau fractures: how reliable are they? Injury 2008;39:1216–21. 10.1016/j.injury.2008.01.023
    1. Doornberg JN, Rademakers MV, van den Bekerom MP, et al. . Two-dimensional and three-dimensional computed tomography for the classification and characterisation of tibial plateau fractures. Injury 2011;42:1416–25. 10.1016/j.injury.2011.03.025
    1. Chen P, Shen H, Wang W, et al. . The morphological features of different Schatzker types of tibial plateau fractures: a three-dimensional computed tomography study. J Orthop Surg Res 2016;11:94 10.1186/s13018-016-0427-5
    1. Chen HW, Liu GD, Wu LJ. Clinical and radiological outcomes following arthroscopic-assisted management of tibial plateau fractures: a systematic review. Knee Surg Sports Traumatol Arthrosc 2015;23:3464–72. 10.1007/s00167-014-3256-2
    1. Egol KA, Cantlon M, Fisher N, et al. . Percutaneous Repair of a Schatzker III Tibial Plateau Fracture Assisted by Arthroscopy. J Orthop Trauma 2017. 31 Suppl 3:S12–S13. 10.1097/BOT.0000000000000892
    1. Craiovan BS, Keshmiri A, Springorum R, et al. . [Minimally invasive treatment of depression fractures of the tibial plateau using balloon repositioning and tibioplasty: video article]. Orthopade 2014;43:930–3. 10.1007/s00132-014-3019-2
    1. Gavaskar AS, Gopalan H, Tummala NC, et al. . The extended posterolateral approach for split depression lateral tibial plateau fractures extending into the posterior column: 2 years follow up results of a prospective study. Injury 2016;47:1497–500. 10.1016/j.injury.2016.04.021
    1. Morin V, Pailhé R, Sharma A, et al. . Moore I postero-medial articular tibial fracture in alpine skiers: Surgical management and return to sports activity. Injury 2016;47:1282–7. 10.1016/j.injury.2016.03.024
    1. Dall’oca C, Maluta T, Lavini F, et al. . Tibial plateau fractures: compared outcomes between ARIF and ORIF. Strategies Trauma Limb Reconstr 2012;7:163–75. 10.1007/s11751-012-0148-1
    1. Kampa J, Dunlay R, Sikka R, et al. . Arthroscopic-Assisted Fixation of Tibial Plateau Fractures: Patient-Reported Postoperative Activity Levels. Orthopedics 2016;39:e486–e491. 10.3928/01477447-20160427-03
    1. Lasanianos NG, Garnavos C, Magnisalis E, et al. . A comparative biomechanical study for complex tibial plateau fractures: nailing and compression bolts versus modern and traditional plating. Injury 2013;44:1333–9. 10.1016/j.injury.2013.03.013
    1. Pizanis A, Garcia P, Pohlemann T, et al. . Balloon tibioplasty: a useful tool for reduction of tibial plateau depression fractures. J Orthop Trauma 2012;26:e88–93. 10.1097/BOT.0b013e31823a8dc8
    1. Ziogas K, Tourvas E, Galanakis I, et al. . Arthroscopy Assisted Balloon Osteoplasty of a Tibia Plateau Depression Fracture: A Case Report. N Am J Med Sci 2015;7:411–4. 10.4103/1947-2714.166223
    1. Jentzsch T, Fritz Y, Veit-Haibach P, et al. . Osseous vitality in single photon emission computed tomography/computed tomography (SPECT/CT) after balloon tibioplasty of the tibial plateau: a case series. BMC Med Imaging 2015;15:56 10.1186/s12880-015-0091-y
    1. Di Caprio F, Buda R, Ghermandi R, et al. . Combined arthroscopic treatment of tibial plateau and intercondylar eminence avulsion fractures. J Bone Joint Surg Am 2010;92 Suppl 2(Suppl 2):161–9. 10.2106/JBJS.J.00812
    1. Ollivier M, Turati M, Munier M, et al. . Balloon tibioplasty for reduction of depressed tibial plateau fractures: Preliminary radiographic and clinical results. Int Orthop 2016;40:1961–6. 10.1007/s00264-015-3047-5
    1. Mauffrey C, Roberts G, Cuellar DO, et al. . Balloon tibioplasty: pearls and pitfalls. J Knee Surg 2014;27:31–7. 10.1055/s-0033-1363516
    1. Elabjer E, Benčić I, Ćuti T, et al. . Tibial plateau fracture management: arthroscopically-assisted versus ORIF procedure - clinical and radiological comparison. Injury 2017. 48 Suppl 5:S61–S64. 10.1016/S0020-1383(17)30742-8
    1. Peel AL, Taylor EW. Proposed definitions for the audit of postoperative infection: a discussion paper. Surgical Infection Study Group. Ann R Coll Surg Engl 1991;73:385–8.
    1. Metcalfe D, Hickson CJ, McKee L, et al. . External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis. J Orthop Traumatol 2015;16:275–85. 10.1007/s10195-015-0372-9
    1. Robertson GAJ, Wong SJ, Wood AM. Return to sport following tibial plateau fractures: A systematic review. World J Orthop 2017;8:574–87. 10.5312/wjo.v8.i7.574
    1. Rossi R, Bonasia DE, Blonna D, et al. . Prospective follow-up of a simple arthroscopic-assisted technique for lateral tibial plateau fractures: results at 5 years. Knee 2008;15:378–83. 10.1016/j.knee.2008.04.001
    1. Rademakers MV, Kerkhoffs GM, Sierevelt IN, et al. . Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 2007;21:5–10. 10.1097/BOT.0b013e31802c5b51
    1. Chen XZ, Liu CG, Chen Y, et al. . Arthroscopy-assisted surgery for tibial plateau fractures. Arthroscopy 2015;31:143–53. 10.1016/j.arthro.2014.06.005
    1. Ruffolo MR, Gettys FK, Montijo HE, et al. . Complications of high-energy bicondylar tibial plateau fractures treated with dual plating through 2 incisions. J Orthop Trauma 2015;29:85–90. 10.1097/BOT.0000000000000203
    1. Chan YS, Yuan LJ, Hung SS, et al. . Arthroscopic-assisted reduction with bilateral buttress plate fixation of complex tibial plateau fractures. Arthroscopy 2003;19:974–84. 10.1016/j.arthro.2003.09.038
    1. Chiu CH, Cheng CY, Tsai MC, et al. . Arthroscopy-assisted reduction of posteromedial tibial plateau fractures with buttress plate and cannulated screw construct. Arthroscopy 2013;29:1346–54. 10.1016/j.arthro.2013.05.003
    1. Ruiz-Iban MA, Diaz-Heredia J, Elias-Martin E, et al. . Cebreiro Martinez Del Val I (2012) Repair of meniscal tears associated with tibial plateau fractures: a review of 15 cases. The American journal of sports medicine;40:2289–95.
    1. Gill TJ, Moezzi DM, Oates KM, et al. . Arthroscopic reduction and internal fixation of tibial plateau fractures in skiing. Clin Orthop Relat Res 2001;383:243–9. 10.1097/00003086-200102000-00028
    1. Doria C, Balsano M, Spiga M, et al. . Tibioplasty, a new technique in the management of tibial plateau fracture: A multicentric experience review. J Orthop 2017;14:176–81. 10.1016/j.jor.2016.12.002

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