MULTIDISCIPLINARY TEAM IN TREATMENT OF HIGH ENERGY TRAUMA OF LEFT LOWER LEG– CASE REPORT
Abstract
High- energy fractures of lower leg are complex lesions that may be associated with soft tissue damage and severe complications, such as compartment syndrome and infection. This case report interests a professional motocross freestyler with complex tibia and fibular open fracture, with soft tissue damage. Case presentation We report the case of 31-year-old man, presented with injuries resulting from accident, as professional freestyler motorcyclist, including open horizontal multifragmentary fracture with angulation of the proximal and middle part of the left tibia and horizontal fracture with angulation of the proximal and middle part of the left fibula. The initial assessment revealed surgical stabilization of the tibia, intramedullary osteosynthesis with wedge. The open lacero-contused wound of the anterior lower leg after the surgery complicated with infection. Necrectomy and Suprasorb A + Ag dressing was performed for per secondar healing of the wound. Conclusion For mounts later, despite the complexity of the fractures, the gravity of the soft tissue lesion and subsequent complications, the patient healed. This satisfactory result depended on the correct management in terms of type of treatment and timing. It highlights the importance of a multidisciplinary approach, incorporating trauma surgeons, plastic and reconstructive surgeon and intensive care specialist to navigate the intricacies of high energy trauma care.
Keywords: injuries, soft tissue damaged, osteosynthesis.
References
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2. Zeltser DW, Leopold SS. Classifications in brief: Schatzker classification of tibial plateau fractures. Clin Orthop Relat Res. 2013;471(2):371–4. doi: 10.1007/s11999-012-2451-z.
3. Sciadini MF, Sims SH. Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type IV tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma. 2013;27:e18–e23. doi: 10.1097/BOT.0b013e31825316ea.
4. Hill AD, Palmer MJ, Tanner SL, et al. Use of continuous passive motion in the postoperative treatment of intra-articular knee fractures. J Bone Joint Surg Am. 2014:96e–118. doi: 10.2106/JBJS.M.00534. [DOI] [PubMed] [Google Scholar].
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6. Ahearn N, Oppy A, Halliday R, et al. The outcome following fixation of bicon dylar tibial plateau fractures. Bone Jt J. 2014;96-B:956e–962. doi: 10.1302/0301-620X.96B7.32837. [DOI] [PubMed] [Google Scholar].
7. Zura RD, Jr Adams SB, Jeray KJ, et al. Timing of definitive fixation of severe tibial plateau fractures with compartment syndrome does not have an effect on the rate of infection. J Trauma. 2010;69:1523. doi: 10.1097/TA.0b013e3181d40403.
8. Hak DJ, Lee M, Gotham DR. Influence of prior fasciotomy on infection after open reduction and internal fixation of tibial plateau fractures. J Trauma. 2010;69:886. doi: 10.1097/TA.0b013e3181b83fe9.
9. Catagni MA, Ottaviani G, Maggioni M. Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma. 2007;63:1043–53. doi: 10.1097/TA.0b013e3181238d88.
10. Jeremy AH, Murray JB, Michael DM. The Canadian Orthopaedic Trauma Society. Open reduction and internal fixation compared with the circular fixator. Application for bicondylar tibial plateau fractures. Surg Technol J Bone Jt Surg Am. 2009;91:74–88. doi: 10.2106/JBJS.G.01165. [DOI] [PubMed] [Google Scholar].
11. Bove F, Sala F, Capitani P, Thabet AM, Scita V, Spagnolo R. Treatment of fractures of the tibial plateau (Schatzker VI) with external fixators versus plate osteosynthesis. Injury. 2018;49(Suppl 3):S12–S18. doi: 10.1016/j.injury.2018.09.059.
12. Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev. 2017 Mar 13;1(5):225–32. doi: 10.1302/2058-5241.1.000031. [DOI] [PMC free article] [PubMed] [Google Scholar].
13. Frattini M, Vaienti E, Soncini G, Pogliacomi F. Tibial plateau fractures in elderly patients. Chir Organi Mov. 2009 Dec;93(3):109–14. doi: 10.1007/s12306-009-0038-y.
14. Hung SS, Chao EK, Chan YS, Yuan LJ, Chung P-H, Chen CY. Arthroscopically assisted osteosynthesis for tibial plateau fractures. J Trauma. 2003;54:356–63. doi: 10.1097/01.TA.0000020397.74034.65.
15. Bengner U, Johnell O, Redlund-Johnell I. Increasing incidence of tibia condyle and patella fractures. Acta Orthop Scand. 1986;57:334–6. doi: 10.3109/17453678608994405.
16 Kokkalis ZT, Iliopoulos ID, Pantazis C, Panagiotopoulos E. What’s new in the management of complex tibial plateau fractures? Injury. 2016 Jun;47(6):1162–9. doi: 10.1016/j.injury.2016.03.001. [DOI] [PubMed] [Google Scholar].
17. Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma. 2005;19(2):79–84. doi: 10.1097/00005131-200502000-00002.
18. Stannard JP, Lopez R, Volgas D. Soft tissue injury of the knee after tibial plateau fractures. J Knee Surg. 2010;23(4):187–92. doi: 10.1055/s-0030-1268694.
19. Ebraheim NA, Sabry FF, Haman SP. Open reduction and internal fixation of 117 tibial plateau fractures. Orthopedics. 2004;27(12):1281–7.
20. Sever JW. Fractures of tuberosities of the tibia: A report of three cases. Am J Orthop Surg. 1916;14:299. [Google Scholar].
21. Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010 Nov;24(11):683–92. doi: 10.1097/BOT.0b013e3181d436f3. [DOI] [PubMed] [Google Scholar].
22. Kfuri M, Schatzker J, Castiglia MT, Giordano V, Fogagnolo F, Stannard JP. Extended Anterolateral Approach for Complex Lateral Tibial Plateau Fractures. J Knee Surg. 2017 Mar;30(3):204–11. doi: 10.1055/s-0037-1598077.
23. Menghi A, Mazzitelli G, Marzetti E, Barberio F, D’Angelo E, Maccauro G. Complex tibial plateau fractures: a retrospective study and proposal of treatment algorithm. Injury. 2017 Oct;48(Suppl 3):S1–S6. doi: 10.1016/S0020-1383(17)30649-6.
24 .Subramanyam KN, Tammanaiah M, Mundargi AV, Bhoskar RN, Reddy PS. Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation. Chin J Traumatol. 2019 Jun;22(3):166–71. doi: 10.1016/j.cjtee.2018.11.003.
25. Chouhan DK, Chand Saini U, Kumar Rajnish R, Prakash M. Complex bicondylar tibial plateau fractures with reversed tibial slope - Our experience with a fracture-specific correction strategy. Trauma Case Rep. 2019 Nov 28;25:100256. doi: 10.1016/j.tcr.2019.100256.
26. Lowe JA, Tejwani N, Yoo B, Wolinsky P. Surgical techniques for complex proximal tibial fractures. J Bone Joint Surg Am. 2011 Aug 17;93(16):1548–59.
27 Chang YH, Tu YK, Yeh WL, Hsu RW. Tibial plateau fracture with compartment syndrome: a complication of higher incidence in Taiwan. Chang Gung Med J. 2000;23(3):149–55.
28. Ziran BH, Becher SJ. Radiographic predictors of compartment syndrome in tibial plateau fractures. J Orthop Trauma. 2013;27(11):612–5. doi: 10.1097/BOT.0b013e31828e25b6.
29. Zura RD, Ja Browne, Black MD, Olson SA. Current management of high-energy tibial plateau fractures. Curr Orthop. 2007;21(3):229–35. [Google Scholar].
30. Berber R, Lewis CP, Copas D, Forward DP, Moran CG. Postero-medial approach for complex tibial plateau injuries with a postero-medial or postero-lateral shear fragment. Injury. 2014;45(4):757–65. doi: 10.1016/j.injury.2013.11.028].
31. Chan YS. Arthroscopy assisted surgery for tibial plateau fractures. Chang Gung Med J. May-Jun 2011;34(3):239–47. [PubMed] [Google Scholar].
32. Young MJ. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994;23:149–54. [PubMed] [Google Scholar].
33. Hall JA, Beuerlein MJ, McKee MD. Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Surgical technique; Canadian Orthopaedic Trauma Society. J Bone Joint Surg Am. 2009 Mar 1;91(Suppl 2 Pt 1):74–88. doi: 10.2106/JBJS.G.01165.
34. McNamara IR, Smith TO, Shepherd KL, et al. Surgical fixation methods for tibial plateau fractures. Cochrane Database Syst Rev. 2015 Sep 15;(9):CD009679. doi: 10.1002/14651858.CD009679.pub2.
35. Pogliacomi F, Verdano MA, Frattini M, Costantino C, Vaienti E, Soncini G. Combined arthroscopic and radioscopic management of tibial plateau fractures: report of 18 clinical cases. Acta Biomed. 2005 Sep;76(2):107–14.
36. Leigheb M, Rusconi M, De Consoli A, et al. Arthroscopically-assisted Reduction and Internal Fixation (ARIF) of tibial plateau fractures: clinical and radiographic medium-term follow-up. Acta Biomed. 2020 May 30;91(4-S):152–9. doi: 10.23750/abm.v91i4-S.9500.
37. Burdin G. Arthroscopic management of tibial plateau fractures: surgical technique. Orthop Traumatol Surg Res. 2013;99(1 Suppl):S208–18. doi: 10.1016/j.otsr.2012.11.011.
38. Herbort M, Domnick C, Petersen W. Arthroscopic treatment of tibial plateau fractures. Oper Orthop Traumatol. 2014;26(6):573–88. doi: 10.1007/s00064-014-0328-x.
39. Siegler J, Galissier B, Marcheix PS, Charissoux JL, Mabit C, Arnaud JP. Percutaneous fixation of tibial plateau fractures under arthroscopy: a medium term perspective. Orthop Traumatol Surg Res. 2011;97(1):44–50. doi: 10.1016/j.otsr.2010.08.005.
40. Kiefer H, Zivaljevic N, Imbriglia JE. Arthroscopic reduction and internal fixation (ARIF) of lateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc. 2001;9(3):167–72. doi: 10.1007/s001670000175.
2. Zeltser DW, Leopold SS. Classifications in brief: Schatzker classification of tibial plateau fractures. Clin Orthop Relat Res. 2013;471(2):371–4. doi: 10.1007/s11999-012-2451-z.
3. Sciadini MF, Sims SH. Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type IV tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma. 2013;27:e18–e23. doi: 10.1097/BOT.0b013e31825316ea.
4. Hill AD, Palmer MJ, Tanner SL, et al. Use of continuous passive motion in the postoperative treatment of intra-articular knee fractures. J Bone Joint Surg Am. 2014:96e–118. doi: 10.2106/JBJS.M.00534. [DOI] [PubMed] [Google Scholar].
5. Ozkaya U, Parmaksizoglu AS. Dual locked plating of unstable bicondylar tibial plateau fractures. Injury. 2015;46(Suppl 2):S9–eS13. doi: 10.1016/j.injury.2015.05.025.
6. Ahearn N, Oppy A, Halliday R, et al. The outcome following fixation of bicon dylar tibial plateau fractures. Bone Jt J. 2014;96-B:956e–962. doi: 10.1302/0301-620X.96B7.32837. [DOI] [PubMed] [Google Scholar].
7. Zura RD, Jr Adams SB, Jeray KJ, et al. Timing of definitive fixation of severe tibial plateau fractures with compartment syndrome does not have an effect on the rate of infection. J Trauma. 2010;69:1523. doi: 10.1097/TA.0b013e3181d40403.
8. Hak DJ, Lee M, Gotham DR. Influence of prior fasciotomy on infection after open reduction and internal fixation of tibial plateau fractures. J Trauma. 2010;69:886. doi: 10.1097/TA.0b013e3181b83fe9.
9. Catagni MA, Ottaviani G, Maggioni M. Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma. 2007;63:1043–53. doi: 10.1097/TA.0b013e3181238d88.
10. Jeremy AH, Murray JB, Michael DM. The Canadian Orthopaedic Trauma Society. Open reduction and internal fixation compared with the circular fixator. Application for bicondylar tibial plateau fractures. Surg Technol J Bone Jt Surg Am. 2009;91:74–88. doi: 10.2106/JBJS.G.01165. [DOI] [PubMed] [Google Scholar].
11. Bove F, Sala F, Capitani P, Thabet AM, Scita V, Spagnolo R. Treatment of fractures of the tibial plateau (Schatzker VI) with external fixators versus plate osteosynthesis. Injury. 2018;49(Suppl 3):S12–S18. doi: 10.1016/j.injury.2018.09.059.
12. Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev. 2017 Mar 13;1(5):225–32. doi: 10.1302/2058-5241.1.000031. [DOI] [PMC free article] [PubMed] [Google Scholar].
13. Frattini M, Vaienti E, Soncini G, Pogliacomi F. Tibial plateau fractures in elderly patients. Chir Organi Mov. 2009 Dec;93(3):109–14. doi: 10.1007/s12306-009-0038-y.
14. Hung SS, Chao EK, Chan YS, Yuan LJ, Chung P-H, Chen CY. Arthroscopically assisted osteosynthesis for tibial plateau fractures. J Trauma. 2003;54:356–63. doi: 10.1097/01.TA.0000020397.74034.65.
15. Bengner U, Johnell O, Redlund-Johnell I. Increasing incidence of tibia condyle and patella fractures. Acta Orthop Scand. 1986;57:334–6. doi: 10.3109/17453678608994405.
16 Kokkalis ZT, Iliopoulos ID, Pantazis C, Panagiotopoulos E. What’s new in the management of complex tibial plateau fractures? Injury. 2016 Jun;47(6):1162–9. doi: 10.1016/j.injury.2016.03.001. [DOI] [PubMed] [Google Scholar].
17. Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma. 2005;19(2):79–84. doi: 10.1097/00005131-200502000-00002.
18. Stannard JP, Lopez R, Volgas D. Soft tissue injury of the knee after tibial plateau fractures. J Knee Surg. 2010;23(4):187–92. doi: 10.1055/s-0030-1268694.
19. Ebraheim NA, Sabry FF, Haman SP. Open reduction and internal fixation of 117 tibial plateau fractures. Orthopedics. 2004;27(12):1281–7.
20. Sever JW. Fractures of tuberosities of the tibia: A report of three cases. Am J Orthop Surg. 1916;14:299. [Google Scholar].
21. Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010 Nov;24(11):683–92. doi: 10.1097/BOT.0b013e3181d436f3. [DOI] [PubMed] [Google Scholar].
22. Kfuri M, Schatzker J, Castiglia MT, Giordano V, Fogagnolo F, Stannard JP. Extended Anterolateral Approach for Complex Lateral Tibial Plateau Fractures. J Knee Surg. 2017 Mar;30(3):204–11. doi: 10.1055/s-0037-1598077.
23. Menghi A, Mazzitelli G, Marzetti E, Barberio F, D’Angelo E, Maccauro G. Complex tibial plateau fractures: a retrospective study and proposal of treatment algorithm. Injury. 2017 Oct;48(Suppl 3):S1–S6. doi: 10.1016/S0020-1383(17)30649-6.
24 .Subramanyam KN, Tammanaiah M, Mundargi AV, Bhoskar RN, Reddy PS. Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation. Chin J Traumatol. 2019 Jun;22(3):166–71. doi: 10.1016/j.cjtee.2018.11.003.
25. Chouhan DK, Chand Saini U, Kumar Rajnish R, Prakash M. Complex bicondylar tibial plateau fractures with reversed tibial slope - Our experience with a fracture-specific correction strategy. Trauma Case Rep. 2019 Nov 28;25:100256. doi: 10.1016/j.tcr.2019.100256.
26. Lowe JA, Tejwani N, Yoo B, Wolinsky P. Surgical techniques for complex proximal tibial fractures. J Bone Joint Surg Am. 2011 Aug 17;93(16):1548–59.
27 Chang YH, Tu YK, Yeh WL, Hsu RW. Tibial plateau fracture with compartment syndrome: a complication of higher incidence in Taiwan. Chang Gung Med J. 2000;23(3):149–55.
28. Ziran BH, Becher SJ. Radiographic predictors of compartment syndrome in tibial plateau fractures. J Orthop Trauma. 2013;27(11):612–5. doi: 10.1097/BOT.0b013e31828e25b6.
29. Zura RD, Ja Browne, Black MD, Olson SA. Current management of high-energy tibial plateau fractures. Curr Orthop. 2007;21(3):229–35. [Google Scholar].
30. Berber R, Lewis CP, Copas D, Forward DP, Moran CG. Postero-medial approach for complex tibial plateau injuries with a postero-medial or postero-lateral shear fragment. Injury. 2014;45(4):757–65. doi: 10.1016/j.injury.2013.11.028].
31. Chan YS. Arthroscopy assisted surgery for tibial plateau fractures. Chang Gung Med J. May-Jun 2011;34(3):239–47. [PubMed] [Google Scholar].
32. Young MJ. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994;23:149–54. [PubMed] [Google Scholar].
33. Hall JA, Beuerlein MJ, McKee MD. Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Surgical technique; Canadian Orthopaedic Trauma Society. J Bone Joint Surg Am. 2009 Mar 1;91(Suppl 2 Pt 1):74–88. doi: 10.2106/JBJS.G.01165.
34. McNamara IR, Smith TO, Shepherd KL, et al. Surgical fixation methods for tibial plateau fractures. Cochrane Database Syst Rev. 2015 Sep 15;(9):CD009679. doi: 10.1002/14651858.CD009679.pub2.
35. Pogliacomi F, Verdano MA, Frattini M, Costantino C, Vaienti E, Soncini G. Combined arthroscopic and radioscopic management of tibial plateau fractures: report of 18 clinical cases. Acta Biomed. 2005 Sep;76(2):107–14.
36. Leigheb M, Rusconi M, De Consoli A, et al. Arthroscopically-assisted Reduction and Internal Fixation (ARIF) of tibial plateau fractures: clinical and radiographic medium-term follow-up. Acta Biomed. 2020 May 30;91(4-S):152–9. doi: 10.23750/abm.v91i4-S.9500.
37. Burdin G. Arthroscopic management of tibial plateau fractures: surgical technique. Orthop Traumatol Surg Res. 2013;99(1 Suppl):S208–18. doi: 10.1016/j.otsr.2012.11.011.
38. Herbort M, Domnick C, Petersen W. Arthroscopic treatment of tibial plateau fractures. Oper Orthop Traumatol. 2014;26(6):573–88. doi: 10.1007/s00064-014-0328-x.
39. Siegler J, Galissier B, Marcheix PS, Charissoux JL, Mabit C, Arnaud JP. Percutaneous fixation of tibial plateau fractures under arthroscopy: a medium term perspective. Orthop Traumatol Surg Res. 2011;97(1):44–50. doi: 10.1016/j.otsr.2010.08.005.
40. Kiefer H, Zivaljevic N, Imbriglia JE. Arthroscopic reduction and internal fixation (ARIF) of lateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc. 2001;9(3):167–72. doi: 10.1007/s001670000175.
Published
2025-11-25
How to Cite
GADZEVSKA TOMULEVSKA, Ilina; MITEV, Konstantin; TAUSHANOV, Mihail.
MULTIDISCIPLINARY TEAM IN TREATMENT OF HIGH ENERGY TRAUMA OF LEFT LOWER LEG– CASE REPORT.
Journal of Morphological Sciences, [S.l.], v. 8, n. 2, p. 245-251, nov. 2025.
ISSN 2545-4706.
Available at: <https://www.jms.mk/jms/article/view/vol8no2-29>. Date accessed: 30 nov. 2025.
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Section
Case Report
