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  • Author: E Carlos Rodríguez-Merchán x
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Elena Gálvez-Sirvent Department of Orthopaedic Surgery, “Infanta Elena” University Hospital, Valdemoro, Madrid, Spain
Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain

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Aitor Ibarzábal-Gil Department of Orthopaedic Surgery, “La Paz” University Hospital, Madrid, Spain

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E Carlos Rodríguez-Merchán Department of Orthopaedic Surgery, “La Paz” University Hospital, Madrid, Spain
Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain

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  • Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis.

  • The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA.

  • Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection.

  • In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage).

  • Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.

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E Carlos Rodríguez-Merchán Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain
Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain

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Carlos A Encinas-Ullán Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

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Juan S Ruiz-Pérez Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

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Primitivo Gómez-Cardero Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

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  • The complication rate of ankle arthroscopy (AA) ranges from 3.5% to 14%.

  • To avoid such complications, it is essential to have a thorough understanding of the anatomy of the ankle, to perform the procedure very carefully and with appropriate instrumentation, and to use a non-invasive distraction technique.

  • The most frequent complications are neurological (cutaneous nerve injuries), which are usually caused by direct injury during arthroscopic portals or by a distracting pin when using an invasive distraction technique. They usually resolve spontaneously within a few months.

  • The iatrogenic formation of a pseudoaneurysm is a severe but extremely rare complication (an incidence of 0.008%).

  • There are several treatments for pseudoaneurysms: external compression; direct thrombin injection, surgical intervention (resection of the damaged segment of the artery and reconstruction with a reversed long saphenous vein interposition graft), and endovascular embolisation.

  • Other rare complications include wound infections (localised superficial infection), problems at the portal incisions (prolonged portal drainage, residual pain in the portal, portal scar dehiscence, cyst at the portal site), type I complex regional pain syndrome, instrument breakage, painful scars and nodules, and a number of other rarer complications.

  • In conclusion, when performing AA, it is important to remember the potential complications and try to avoid them. When they do occur, it is essential to diagnose and treat them appropriately.

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