SURGICAL TREATMENT OF TIBIAL PLATEAU FRACTURES

The purpose of the surgical treatment of tibial plateau fractures is to get a stable, powerfull and mobile joint. The importance of surgical planning is that a stable post operative fixation is directly proportional to postoperative arthrosis. The material of this study consists of thirty out of 72 patients who responded to our call for control examination, treated surgically at the Department of Orthopaedics and Traumatology, Istanbul Medical Faculty between March 1980 and June 1992. 18 patients were male (%60) and 12 female (%40), mean age was 51.6 (min. 30-max. 77) and the mean follow-up 5.9 years (inin. 6 mounths-max. 12 years). The cases have been classified according to Hohl's system. As an internal fixation device, we used plate and screws in 11 patients, cortical and spongios screws in 10 patients, Bolt screw in 4 patients and no device in 5 patients. The plateau depression has been reconstructed with elevation through a window in the bone distal to the plate with a corticospongios iliac crest graft and a crashed medial tibial condile has been reconstructed with an iliac crest graft in one patient. The results are evaluated according to Hohl's and Delamarter's clasification systems; 5 patients have scored excellent (16%), 12 patients good (36.6%), 11 patients fair (36.6%) and 2 patients poor (10%).

TÝBÝA PLATO KIRIKLARININ CERRAHÝ TEDAVÝSÝ

Tibia plato kýrýklarýnýn tedavisinde amaç stabil güçlü ve hareketli bir diz eklemi elde etmektir. Elde edilecek stabil bir fiksasyon, postop artroz riskiyle direkt iliþkili olduðundan, tedavi planlamasý ayrýca önem arz etmektedir. Çalýþmamýzda, Ýstanbul Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji ABD'da Mart 1980-Haziran 1992 tarihleri arasýnda cerrahi tedavi uygulanan 72 hastadan, çaðrýmýza uyarak son kontrollerine gelen 30 vaka materyalimizi oluþturmuþtur. Vakalarýmýzýn 18'i erkek (%60), 12'si kadýn (%40) olup ortalama yaþ (en küçük 30 en büyük 77) 51.6, takip süreleri ortalama (en az. 6 ay-en çok 12 yýl) 5.9 yýl idi. Vakalarýmýzýn preop sýnýflamasýnda Hohl klasifikasyonu kullanýlmýþtýr. Ýnternal tesbit olarak 11 vakada plak-vida, 10 vakada kortikal ve spongiöz vida, 4 vakada bolt vidasý kullanýlmýþ, 5 vakada internal tesbit uygulanmamýþtýr. 11 vakada platodaki çökme plato distalinden açýlan bir pencereden iliak-spongiöz greftler kullanýlarak yükseltilmiþ, 1 vakada aþýrý parçalanma gösteren iç kondile kristadan blok greft alýnarak yeni bir plato oluþturulmuþtur. Sonuçlar Delamarter ve Hohl'ün önerdikleri kriterlere göre deðerlendirilmiþ, buna göre, 5 vaka (%16) çok iyi, 12 vakada (%36.6) iyi, 11 vaka (%36.6) orta ve 2 vaka (%10) kötü olarak deðerlendirilmiþtir.