Table 3.14. Rate of autologous bone grafting into fractures
Bone grafting
Type V | Type VI | Total 2 types | |
n=19 (%) | n=80 (%) | n=99 (%) | |
Are not | 19 (100) | 73 (91.2) | 92 (92.9) |
Have | 0 (0) | 7 (8.8) | 7 (7.1) |
Total | 19 (100) | 80 (100) | 99 (100) |
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Comments: Seven patients (7.1%) had autologous iliac crest bone grafted below the depression. All cases of bone grafting below the depression were type VI fractures.
3.2.1.3 Surgery time
Table 3.15. Surgical time according to fracture type
Surgery time (minutes)
Type V
n=19 (%)
Type VI
n=80 (%)
Total 2 types
n=99 (%)
Average 52.1 ± 13.6 60.4 ± 17.1 58.8 ± 16.7
31 – 60 minutes 16 (84.2) 51 (63.8) 67 (67.7)
61 – 90 minutes 3 (15.8) 25 (31.2) 28 (28.3)
91 – 120 minutes 0 (0) 4 (5) 4 (4)
Total 19 (100) 80 (100) 99 (100)
Comments: 67.7% of patients had surgery within 60 minutes, 28.3% of patients had surgery time of 61 - 90 minutes. 4% of patients had surgery time of 91 - 120 minutes. The average surgery time was 58.8 ± 16.7 minutes, the highest was 120 minutes, the lowest was 35 minutes. There was no difference in the average surgery time between the type V fracture group and the type VI fracture group (p = 0.05, Chi- Square Tests).
Table 3.16. Operative time with compartment syndrome
Squeeze
compartment
Number of patients
PT Time Minimum average time
(minutes) (minutes)
Time
maximum (minute)
p
No 85 55.7 ± 13.5 35 95 p <
0.001
Yes 14 77.7 ± 21.8 40 120
Comments: The average operative time in the group without compartment compression was 55.7 ± 13.5 minutes, much lower than that in the group with compartment compression.
77.7 ± 21.8 min. The difference is significant with p < 0.001(T-Test).
Method Number of osteopathic patients | PT time average (minutes) | Time minimum (minute) | Time maximum (minute) | p* |
Closed 91 | 57.5 ± 15.7 | 35 | 120 | |
Open at least 5 | 68.0 ± 25.6 | 40 | 110 | 0.8 |
Open at least 3 | 83.3 ± 5.8 | 80 | 90 | 0.02 |
Table 3.17. Surgery time according to osteopathic method
capsule
*One-way Anova
Comment: The average surgical time was lowest in the closed reduction group.
57.5 ± 15.7 minutes, followed by the minimal opening group at the metaphysis 68.0 ± 25.6 minutes, highest in the minimal opening group at the joint capsule.
The difference in operative time between the closed reduction group and the minimally open group at the metaphysis was not statistically significant with p=0.8. The operative time in the closed reduction group was shorter than the minimally open group at the joint capsule, this difference was statistically significant with p=0.02. There was no difference in operative time between the 2 groups of minimally open at the metaphysis and minimally open at the joint capsule (p=0.6).
3.2.1.4 Results of tibial plateau correction
Table 3.18. Degree of lateral tibial plateau subsidence immediately after surgery
MC settlement level outside
Type V | Type VI | Total 2 types | |
(mm) | n=19 (%) | n=80 (%) | n=99 (%) |
Medium | 0.5 ± 0.9 | 0.9 ± 1.2 | 0.84 ± 1.1 |
0 mm | 13(68.4) | 46 (57.5) | 59 (59.6) |
1 – 3mm | 6 (31.6) | 31 (38.8) | 37 (37.4) |
4 – 6 mm | 0 (0) | 3 (3.8) | 3 (3.0) |
Total | 19 (100) | 80 (100) | 99 (100) |
Comment:
59.6% of patients no longer had lateral tibial plateau subsidence after surgery. 40.4% of patients still had lateral tibial plateau subsidence at different levels, of which: 37.4% still had 1-3mm subsidence, 3% still had 4mm subsidence, and no case had subsidence greater than 4mm.
Table 3.19. Comparison of lateral tibial plateau subsidence before and immediately after surgery
Tibial plateau depression
outside (mm)
Medium
Smallest
Biggest
p*
2.31 ± 1.9 | 0 | 7 | |
Post-operative | 0.84 ± 1.1 | 0 | 4 0.000 |
* Wilcoxon test
Comments: The average postoperative lateral tibial plateau subsidence was 0 mm, much improved compared to the preoperative level of 3 mm; there was a significant difference between the preoperative and postoperative lateral tibial plateau subsidence with p < 0.000 (Wilcoxon test).
Table 3.20. Degree of medial tibial plateau subsidence immediately after surgery
MC settlement level in
Type V | Type VI | Total 2 types | |
(mm) | n=19 (%) | n=80 (%) | n=99 (%) |
Medium | 0 | 0.3 ± 0.7 | 0.25 ± 0.7 |
0 mm | 19 (100) | 67 (83.8) | 86 (86.9) |
1 – 3mm | 0 (0) | 13 (16.2) | 13 (13.1) |
Total | 19 (100) | 80 (100) | 99 (100) |
Comment:
After surgery, most cases (86.9%) no longer had medial tibial plateau subsidence, only 13.1% of patients had medial tibial plateau subsidence.
Table 3.21. Comparison of the degree of medial tibial plateau subsidence before and immediately after surgery
Medial tibial plateau depression
(mm)
Medium
Smallest Largest p*
0.6 ± 1.3 | 0 | 5 | ||
Post-operative | 0.2 ± 0.7 | 0 | 3 | 0.000 |
*Wilcoxon test
Comment:
The mean postoperative medial tibial plateau subsidence was 0.2 mm, significantly lower than before surgery (0.6 mm); the difference was statistically significant with p < 0.000 (Wilcoxon test).
Table 3.22. Degree of increase in tibial plateau width on the surface immediately after surgery
Increased MC width on Type V
Type VI | Total 2 types | |
Surface area (mm) n=19 (%) | n=80 (%) | n=99 (%) |
Average 0.5 ± 0.9 | 0.8 ± 1.1 | 0.71 ± 1.1 |
0mm 14 (73.7) | 54 (67.5) | 68 (68.7) |
1 – 5mm 5 (26.3) | 26 (32.5) | 31(31.3) |
Total 19 (100) | 80 (100) | 99 (100) |
Comments: 68.7% of patients no longer had an increase in the width of the tibial plateau on the surface immediately after surgery. 31/99 patients (31.3%) still had an increase in the width of the tibial plateau after surgery in the range of 1 - 5mm. Of these, only 2 patients ( patients number 34 and number 85 in the Appendix of patient list ) still had an increase in the width of the MC after surgery of 4mm. There were no cases of an increase in the width of the tibial plateau on the surface after surgery of more than 4mm.
Table 3.23. Comparison of increased tibial plateau width on the preoperative and immediate postoperative planes
Increase the width of the upper MC
Surface area (mm)
Medium
Smallest
Biggest
p*
Preoperative 3.90 ± 2.0 0 10
Postoperative 0.71 ± 1.1 0 4 0.000
*Wilcoxon test
Comments: The average increase in tibial plateau width on the postoperative surface was 0 mm, much better than the preoperative 4 mm, the difference was statistically significant with p < 0.000 (Wilcoxon test).
Table 3.24. Degree of increase in tibial plateau width on the lateral plane immediately after surgery
Increased MC width on Type V
Type VI | Total 2 types | |
side plane (mm) n=19 (%) | n=80 (%) | n=99 (%) |
Average 0.7 ± 0.9 | 0.3 ± 0.7 | 0.40 ± 0.8 |
0mm 12 (63.2) | 65 (81.3) | 77 (77.8) |
1 – 3mm 7 (36.8) | 15 (18.7) | 22 (22.2) |
Total 19 (100) | 80 (100) | 99 (100) |
Comment:
77.8% of patients after reduction no longer had increased tibial plateau width on the lateral plane. 22/99 patients (22.2%) still had increased tibial plateau width on the lateral plane after surgery within the range of 1 - 3 mm.
Table 3.25. Comparison of increased tibial plateau width on the lateral plane
before and immediately after surgery
Increase MC width on lateral plane (mm)
Medium | Smallest | Biggest | p* | |
Before surgery | 0.47 ± 0.9 | 0 | 3 | |
Post-operative | 0.4 ± 0.8 | 0 | 2 | 0.06 |
*Wilcoxon test
Comments: The average increase in tibial plateau width on the lateral plane after surgery was 0.4 mm, and before surgery was 0.5 mm; however, this difference was not statistically significant with p = 0.06 (Wilcoxon test).
Table 3.26. Difference in tibiofemoral angle immediately after surgery
Postoperative tibiofemoral angle difference
Type V
n=19 (%)
Type V
n=80 (%)
Total 2 types
n=99 (%)
0 o 5 (26.3) 16 (20) 21(21.2)
14 (73.7) | 64 (80) | 78 (78.8) | ||
6 o -10 o | 0 (0) | 0 (0) | 0 (0) | |
Total | 19 (100) | 80 (100) | 99 (100) |
Comments: After surgery, 100% of patients had a difference in tibiofemoral angle compared to the healthy leg within the range of 0 o -5 o , meaning that 100% of patients had a difference in tibiofemoral angle index classified as very good and good (according to Honkonen's standards).
3.2.2. Bone healing results
3.2.2.1 Bone healing rate
The bone healing rate achieved was 100%, with no cases requiring a second bone graft or second surgery.
3.2.2.2 Bone healing time
Table 3.27. Bone healing time according to fracture classification
Time to heal Number Average Small Large p* bone (weeks) amount (weeks) most most
Type V | 19 | 15.2 ± 1.5 | 12 | 17 | |
Type VI | 80 | 16.5 ± 1.7 | 12 | 20 | 0.003 |
Total | 99 | 16.2 ± 1.8 | 12 | 20 | |
*T-test |
Comment: The average bone healing time of the study group was
16.2 ± 1.8 weeks, lowest 12 weeks, highest 20 weeks. The average bone healing time of type V tibial plateau fractures was 15.2 ± 1.5 weeks, statistically lower than the average bone healing time of type VI tibial plateau fractures of 16.5 ± 1.7 with p=0.003 (T-test).
Table 3.28. Bone healing time according to osteopathy method
Time
bone (week)
Number
quantity
Medium
(week)
Small
best
Big
best
p*
Closed 91 16.2 ± 1.8 12 20
Open at least 5
onion
Open at least 3
joint capsule
*One way Anova
16.4 ± 0.6 12 17
16.7 ± 1.5 12 18
p = 1
p = 1
Comment: There was no significant difference in mean bone healing time between different osteotomy methods (p=0.9).
3.2.2.3 Time of wearing external fixation frame
79 patients had their external fixator removed in the operating room and had it removed on the same day as scheduled. The remaining 20 patients had their external fixator removed in the operating room and it was done 1-2 weeks after scheduled time. Table 3.28 shows the mean values of the time wearing the external fixator.
Table 3.29. Time wearing external fixator
Small | Big | |||
External fixation (weeks) | (week) | best | best | |
Type V | 19 | 15.3 ± 1.5 | 12 | 17 |
Type VI | 80 | 16.7 ± 1.6 | 12 | 20 |
Total | 99 | 16.4 ± 1.8 | 12 | 20 |