title: "Fracturoscopy" is Superior to Fluoroscopy in the Articular Reconstruction of Complex Tibial Plateau Fractures-An Arthroscopy Assisted Fracture Reduction Technique.
abstract: OBJECTIVE
  To analyze the anatomic accuracy of fracture reduction controlled by fluoroscopy as compared with arthroscopically assisted reduction ("fracturoscopy") in patients with complex tibial plateau fractures (AO/OTA 41-C). Quality of fracturoscopy-guided reduction was checked with postoperative computed tomography.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Urban level 1 trauma center.
  
  
  METHODS
  Seventeen consecutive patients, with a complex, bicondylar tibial plateau fracture.
  
  
  METHODS
  The intraoperative, open insertion of an arthroscope (2.4-mm or 2.8-mm optics), to visualize the articular surface and fracture reduction.
  
  
  METHODS
  Ability to detect residual fracture depression or gap after previous open reduction under fluoroscopic guidance.
  
  
  RESULTS
  An open fracture reduction with fluoroscopic guidance was performed in all cases. In 7 cases, open reduction and fluoroscopy resulted in satisfactory fracture reduction (fluoroscopy group). In 10 of 17 cases, subsequent "fracturoscopy" showed persistent fracture depression (≥2 mm, fracturoscopy group) with the need for intraoperative correction. Patients in the fracturoscopy group demonstrated significantly greater preoperative fragment depression (12.55 ± 6.56 mm) and a larger preoperative fracture gap (7.83 ± 5.49 mm) compared with patients with a satisfactory reduction under fluoroscopy (depression 4.97 ± 4.02 mm, P = 0.016; gap 2.47 ± 1.07 mm, P = 0.023). Fluoroscopy was not successful in achieving satisfactory reduction in cases in which the postero-latero-central region was affected (P = 0.004, χ test). Postoperative computed tomography demonstrated satisfactory articular reconstruction in all cases.
  
  
  CONCLUSIONS
  Intraoperative fracturoscopy permitted a significantly improved visualization of fracture fragment displacement, specifically in the postero-latero-central region of the tibial plateau, as compared with fluoroscopy. Fracturoscopy is recommended for fractures involving the postero-latero-central region of the tibial plateau.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Departments of *Trauma and Reconstructive Surgery, and †Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Krause
authors.forename: Achim
authors.initials: A
authors.lastname: Preiss
authors.forename: Norbert M
authors.initials: NM
authors.lastname: Meenen
authors.forename: Jürgen
authors.initials: J
authors.lastname: Madert
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Frosch
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013978:Tibial Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome