Al-Razi Orthopedic Hospital, Kuwait
Title: Minimal invasive treatment protocol for closed complex tibial plateau fractures
Sherif Mohamed Abdelgaid has completed his MSc (Orthop) from Cairo University in Egypt and MD (Orthop) from Banha University, Egypt. He is working now as a consultant of orthopedic surgery in Al-Razi orthopedic hospital in Kuwait. His main interest is the minimally invasive orthopedic trauma surgeries. He has published and publishing several papers in reputed journals. His focus is mainly in minimal invasive treatment in orthopedic trauma. He actively participated in the organization of 21 international orthopedic conferences and workshops. He is an affiliate member of the American academy of orthopedic surgeons.
Tibial plateau fractures due to high-energy trauma are complex injuries frequently associated with soft tissue injuries and complications. Although, open reduction and internal fixation can restore the joint anatomy, it increases the risk of soft tissue complications like infection and wound dehiscence. It also may inhibit the early postoperative knee mobilization impairing the articular cartilage nutrition. Surgical options include open or biologic, internal or external fixation with a lot of available fixation tools with no one treatment method has demonstrated superiority over other. We designed a protocol of minimally invasive treatment options aiming to choose the appropriate method of treatment for each type of these fractures decreasing the anticipated complications. Our protocol depends on regional classification and grading of soft tissue injuries & and type of plateau fracture. Between January 2006 and December 2010 we treated 42 cases with complex tibial plateau fractures using this protocol. After a mean follow up period of 46 months, 90% of the patients were satisfied and resumed their preoperative activities. The mean Ramussen clinical score was 26.7 points without poor outcomes. The main Ramussen radiologic score was 16.5 points, also without poor outcome. The suggested protocol provides the treating surgeon a variety of treatment options aiming to decrease the risk of soft tissue complications like infection and wound dehiscence and allows early postoperative knee mobilization. The protocol is applicable in all cases of complex tibial plateau fractures except cases with severe comminution.