title: Moore I postero-medial articular tibial fracture in alpine skiers: Surgical management and return to sports activity.
abstract: OBJECTIVE
  Over the past 10 years, like many authors, we observed an increasing number of Moore I tibial plateau fractures related to alpine skiing for which the surgeon may face difficult choices regarding surgical approach and fixation means. Some authors have recently been suggesting a posterior approach associated to open reduction and osteosynthesis by a buttress plate. But in our knowledge there is no specific study on sports activity recovery after Moore I tibial fractures. The aim of this work was to assess sports activities and clinical outcomes after surgically treated Moore I tibial plateau fractures in an athletic population of skiers.
  
  
  METHODS
  We conducted a prospective case series between 2012 and 2014. This included fifteen patients aged 39.6±7 years whom presented with a Moore I tibial plateau fracture during a skiing accident. 12 cases (80%) presented with an associated tibial spine fracture. Treatment consisted of a standard antero-medial approach, with a medial para patellar arthrotomy to allow direct visualisation of articular reduction and spinal fixation. Two or three 6.5mm long cancellous bone screws were placed antero-posteriorly so as to ensure perfect compression of the fracture site. Radiological and functional results were assessed by an independent observer (Lysholm-Tegner, UCLA, KOOS scores) at the longest follow-up.
  
  
  RESULTS
  Mean follow-up was 18.2±6 months (12-28). An immediate postoperative anatomical reduction was achieved in all cases and remained stable in time. At last follow-up Lysholm mean score was 85±14 points (59-100), UCLA score was 7.3±1.6 (4-10) and Tegner score was 4.6±1.3 (3-6). Mean KOOS score was 77±15 (54-97). 87% of patients had resumed their skiing activity and 93% were satisfied or very satisfied from their post-operative surgical outcome. We observed no pseudarthrosis or secondary varus displacement.
  
  
  CONCLUSIONS
  In our series 87% of patients had resumed back to their sporting activities. Surgical management of Moore I tibial plateau fractures by isolated antero-posterior screwing provides excellent clinical and radiological results. The anteromedial incision has a dual advantage of anatomical reduction, tibial spine fixation (in 80% of our cases) and posteromedial fragment reduction.
authors.affiliation: Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130 Échirolles, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Morin
authors.affiliation: Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130 Échirolles, France. Electronic address: regis.pailhe@gmail.com.
authors.forename: Régis
authors.initials: R
authors.lastname: Pailhé
authors.affiliation: The Royal Orthopaedic Hospital, Birmingham, United Kingdom.
authors.forename: Akash
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130 Échirolles, France.
authors.forename: René-Christopher
authors.initials: RC
authors.lastname: Rouchy
authors.affiliation: Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130 Échirolles, France.
authors.forename: Jérémy
authors.initials: J
authors.lastname: Cognault
authors.affiliation: Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130 Échirolles, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Rubens-Duval
authors.affiliation: Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130 Échirolles, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Saragaglia
mesh_terms: D000328:Adult; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004204:Joint Dislocations / Q000601:surgery*; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D000068958:Return to Sport / Q000706:statistics & numerical data*; D012865:Skiing / Q000293:injuries*; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Fracture; Isolated screwing; Moore I; Skiing; Tibial plateau