{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:39:39Z","timestamp":1787755179718,"version":"build-2784847793"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2017,4,18]],"date-time":"2017-04-18T00:00:00Z","timestamp":1492473600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS OA"],"published-print":{"date-parts":[[2017,6,26]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Bicondylar tibial plateau fractures have been treated with either plating or external fixation techniques, with conflicting results. A recently introduced technique involving the combined use of intramedullary nailing via a suprapatellar approach and condylar bolts could represent a new pathway toward better treatment of this severe injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The present report describes a retrospective and prospective study of all 17 patients (age range, 25 to 75 years) who were admitted under the author\u2019s care for the treatment of a closed, bicondylar tibial plateau fracture between 2013 and 2015. All patients consented to undergo fixation of the fracture with intramedullary nailing through a suprapatellar approach and with use of condylar bolts. The reconstructed articular surface was supported with freeze-dried allograft that had been previously soaked in concentrated bone marrow. The patients were followed at regular intervals, and the results were assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>All patients were followed for at least 1 year (average and standard deviation, 25.23 \u00b1 8.95 months; range, 12 to 46 months). All fractures united clinically and radiographically between 10 and 22 weeks (average, 15.1 \u00b1 2.91 weeks), with no instances of neurovascular complication, infection, or implant failure. One patient underwent early revision of the fixation because of unsatisfactory reduction of the articular surface, and 1 patient had secondary fracture displacement. One condylar bolt was removed after fracture healing because of irritation at the insertion site. However, all patients regained knee motion without physiotherapy and all were fully weight-bearing by the fifth postoperative month.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The short and intermediate-term results associated with the use of the proposed technique appear to be satisfactory. However, the effectiveness of the technique should be reassessed with long-term studies as well as comparative studies involving other fixation techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.16.00017","type":"journal-article","created":{"date-parts":[[2017,4,18]],"date-time":"2017-04-18T11:05:16Z","timestamp":1492513516000},"page":"e0017","source":"Crossref","is-referenced-by-count":15,"title":["Intramedullary Nailing with a Suprapatellar Approach and Condylar Bolts for the Treatment of Bicondylar Fractures of the Tibial Plateau"],"prefix":"10.2106","volume":"2","author":[{"given":"Christos","family":"Garnavos","sequence":"first","affiliation":[{"name":"Orthopaedic Department, \u201cEvangelismos\u201d General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,4,18]]},"reference":[{"issue":"10","key":"R1-20230901","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","article-title":"Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee","volume":"21","author":"Marsh","year":"2007","journal-title":"J Orthop Trauma"},{"key":"R2-20230901","first-page":"94","article-title":"The tibial plateau fracture. The Toronto experience 1968\u20131975","volume":"138","author":"Schatzker","year":"1979","journal-title":"Clin Orthop Relat Res."},{"issue":"6","key":"R3-20230901","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.injury.2005.06.035","article-title":"Complications after tibia plateau fracture surgery","volume":"37","author":"Papagelopoulos","year":"2006","journal-title":"Injury"},{"issue":"10","key":"R4-20230901","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1007\/s00402-007-0520-7","article-title":"Open reduction and internal fixation versus hybrid fixation for bicondylar\/severe tibial plateau fractures: a systematic review of the literature","volume":"128","author":"Mahadeva","year":"2008","journal-title":"Arch Orthop Trauma Surg"},{"issue":"12","key":"R5-20230901","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.2106\/00004623-200612000-00008","article-title":"Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial","volume":"88","year":"2006","journal-title":"J Bone Joint Surg Am."},{"key":"R6-20230901","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/1749-799X-6-35","article-title":"High energy tibial plateau fractures treated with hybrid external fixation","volume":"6","author":"Babis","year":"2011","journal-title":"J Orthop Surg Res."},{"issue":"8","key":"R7-20230901","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1097\/00005131-200409000-00012","article-title":"The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results","volume":"18","author":"Stannard","year":"2004","journal-title":"J Orthop Trauma"},{"issue":"2","key":"R8-20230901","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/BOT.0b013e318030df96","article-title":"Complications of locking plate fixation in complex proximal tibia injuries","volume":"21","author":"Phisitkul","year":"2007","journal-title":"J Orthop Trauma"},{"issue":"2","key":"R9-20230901","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.knee.2007.12.001","article-title":"A comparative study of Less Invasive Stabilization System (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures","volume":"15","author":"Jiang","year":"2008","journal-title":"Knee"},{"issue":"2","key":"R10-20230901","doi-asserted-by":"crossref","first-page":"86","DOI":"10.5435\/00124635-199503000-00004","article-title":"Tibial plateau fractures: evaluation and treatment","volume":"3","author":"Koval","year":"1995","journal-title":"J Am Acad Orthop Surg"},{"key":"R11-20230901","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/00003086-200510000-00036","article-title":"Single lateral locked screw plating of bicondylar tibial plateau fractures","volume":"439","author":"Gosling","year":"2005","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"R12-20230901","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.injury.2014.01.008","article-title":"Retropatellar nailing and condylar bolts for complex fractures of the tibial plateau: technique, pilot study and rationale","volume":"45","author":"Garnavos","year":"2014","journal-title":"Injury"},{"issue":"10","key":"R13-20230901","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.injury.2011.03.024","article-title":"The management of complex fractures of the proximal tibia with minimal intra-articular impaction in fragility patients using intramedullary nailing and compression bolts","volume":"42","author":"Garnavos","year":"2011","journal-title":"Injury"},{"issue":"1","key":"R14-20230901","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s00402-012-1629-x","article-title":"Biomechanical comparison of intramedullar versus extramedullar stabilization of intra-articular tibial plateau fractures","volume":"133","author":"H\u00f6gel","year":"2013","journal-title":"Arch Orthop Trauma Surg"},{"issue":"3","key":"R15-20230901","doi-asserted-by":"crossref","first-page":"312","DOI":"10.4055\/cios.2014.6.3.312","article-title":"Biomechanical analysis of operative methods in the treatment of extra-articular fracture of the proximal tibia","volume":"6","author":"Lee","year":"2014","journal-title":"Clin Orthop Surg"},{"issue":"10","key":"R16-20230901","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/j.injury.2013.03.013","article-title":"A comparative biomechanical study for complex tibial plateau fractures: nailing and compression bolts versus modern and traditional plating","volume":"44","author":"Lasanianos","year":"2013","journal-title":"Injury"},{"issue":"10","key":"R17-20230901","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.injury.2008.04.005","article-title":"The use of freeze-dried cancelous allograft in the management of impacted tibial plateau fractures","volume":"39","author":"Lasanianos","year":"2008","journal-title":"Injury"},{"issue":"11","key":"R18-20230901","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1097\/BOT.0b013e3181d436f3","article-title":"Three-column fixation for complex tibial plateau fractures","volume":"24","author":"Luo","year":"2010","journal-title":"J Orthop Trauma"},{"issue":"2","key":"R19-20230901","doi-asserted-by":"crossref","first-page":"88","DOI":"10.2519\/jospt.1998.28.2.88","article-title":"Knee injury and Osteoarthritis Outcome Score (KOOS)\u2014development of a self-administered outcome measure","volume":"28","author":"Roos","year":"1998","journal-title":"J Orthop Sports Phys Ther"},{"key":"R20-20230901","article-title":"Surgical fixation methods for tibial plateau fractures","volume":"9","author":"McNamara","year":"2015","journal-title":"Cochrane Database Syst Rev."},{"issue":"6","key":"R21-20230901","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1016\/j.injury.2016.03.001","article-title":"What\u2019s new in the management of complex tibial plateau fractures?","volume":"47","author":"Kokkalis","year":"2016","journal-title":"Injury"},{"issue":"5","key":"R22-20230901","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1097\/00005373-198105000-00007","article-title":"Fractures of the tibial plateau: a review of ninety-five patients and comparison of treatment methods","volume":"21","author":"Waddell","year":"1981","journal-title":"J Trauma"},{"issue":"2","key":"R23-20230901","first-page":"149","article-title":"Complications of internal fixation of tibial plateau fractures","volume":"23","author":"Young","year":"1994","journal-title":"Orthop Rev."},{"issue":"3","key":"R24-20230901","first-page":"263","article-title":"Tibial plateau fractures: standardized evaluation of operative results","volume":"14","author":"Stokel","year":"1991","journal-title":"Orthopedics"},{"issue":"10","key":"R25-20230901","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/00005131-200411000-00001","article-title":"Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique","volume":"18","author":"Barei","year":"2004","journal-title":"J Orthop Trauma"},{"issue":"8","key":"R26-20230901","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s00113-007-1271-1","article-title":"[Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation]","volume":"110","author":"Partenheimer","year":"2007","journal-title":"Unfallchirurg"},{"issue":"Suppl 1","key":"R27-20230901","doi-asserted-by":"crossref","first-page":"A30","DOI":"10.1016\/S0020-1383(03)00255-9","article-title":"Stabilization of proximal tibial fractures with the LIS-System: early clinical experience in Berlin","volume":"34","author":"Sch\u00fctz","year":"2003","journal-title":"Injury"},{"issue":"Suppl 1","key":"R28-20230901","doi-asserted-by":"crossref","first-page":"A16","DOI":"10.1016\/S0020-1383(03)00254-7","article-title":"Less Invasive Stabilization System (LISS) for fractures of the proximal tibia: indications, surgical technique and preliminary results of the UMC Clinical Trial","volume":"34","author":"Cole","year":"2003","journal-title":"Injury"},{"issue":"8","key":"R29-20230901","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/00005131-199911000-00005","article-title":"A biomechanical analysis of internal fixation of complex tibial plateau fractures","volume":"13","author":"Horwitz","year":"1999","journal-title":"J Orthop Trauma"},{"issue":"5","key":"R30-20230901","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/BOT.0b013e3180500359","article-title":"Biomechanical analysis of bicondylar tibial plateau fixation: how does lateral locking plate fixation compare to dual plate fixation?","volume":"21","author":"Higgins","year":"2007","journal-title":"J Orthop Trauma"},{"issue":"2","key":"R31-20230901","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/01.TA.0000112326.09272.13","article-title":"Treatment of complex tibial plateau fractures using the Less Invasive Stabilization System plate: clinical experience and a laboratory comparison with double plating","volume":"57","author":"Egol","year":"2004","journal-title":"J Trauma"},{"key":"R32-20230901","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/01.blo.0000238821.71271.cc","article-title":"Wound problems in total knee arthroplasty","volume":"452","author":"Vince","year":"2006","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"R33-20230901","doi-asserted-by":"crossref","first-page":"e516","DOI":"10.3928\/01477447-20110714-42","article-title":"Wound healing problems in total knee arthroplasty","volume":"34","author":"Garbedian","year":"2011","journal-title":"Orthopedics"},{"key":"R34-20230901","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1097\/00003086-199607000-00032","article-title":"Hybrid external fixation of comminuted tibial plateau fractures","volume":"328","author":"Gaudinez","year":"1996","journal-title":"Clin Orthop Relat Res."},{"issue":"12","key":"R35-20230901","first-page":"1433","article-title":"Internal versus external fixation of bicondylar tibial plateau fractures","volume":"21","author":"Mallik","year":"1992","journal-title":"Orthop Rev."},{"issue":"5","key":"R36-20230901","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/00005131-200305000-00005","article-title":"Treatment of displaced bicondylar tibial plateau fractures (OTA-41C2&3) in patients older than 60 years of age","volume":"17","author":"Ali","year":"2003","journal-title":"J Orthop Trauma"},{"issue":"3","key":"R37-20230901","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/00005131-199803000-00014","article-title":"Infections in periarticular fractures of the lower extremity treated with tensioned wire hybrid fixators","volume":"12","author":"Hutson","year":"1998","journal-title":"J Orthop Trauma"},{"key":"R38-20230901","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/01.blo.0000119247.60317.bc","article-title":"Operative treatment of tibial plateau fractures in patients older than 55 years","volume":"421","author":"Su","year":"2004","journal-title":"Clin Orthop Relat Res."},{"issue":"8","key":"R39-20230901","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1097\/00005131-200309000-00013","article-title":"Evidence-Based Orthopaedic Trauma Working Group. Operative treatment of extra-articular proximal tibial fractures","volume":"17","author":"Bhandari","year":"2003","journal-title":"J Orthop Trauma"},{"issue":"11","key":"R40-20230901","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1097\/BOT.0b013e3181c1d675","article-title":"Retropatellar technique for intramedullary nailing of proximal tibia fractures: a cadaveric assessment","volume":"24","author":"Eastman","year":"2010","journal-title":"J Orthop Trauma"},{"issue":"11","key":"R41-20230901","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1097\/BOT.0b013e3181f6bec7","article-title":"The retropatellar portal as an alternative site for tibial nail insertion: a cadaveric study","volume":"24","author":"Eastman","year":"2010","journal-title":"J Orthop Trauma"},{"issue":"11","key":"R42-20230901","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1097\/BOT.0b013e3181f6c001","article-title":"Suprapatellar versus infra-patellar intramedullary nail insertion of the tibia: a cadaveric model for comparison of patellofemoral contact pressures and forces","volume":"24","author":"Gelbke","year":"2010","journal-title":"J Orthop Trauma"},{"issue":"9","key":"R43-20230901","doi-asserted-by":"crossref","first-page":"e1155","DOI":"10.3928\/01477447-20130821-17","article-title":"Comparison of insertional trauma between suprapatellar and infrapatellar portals for tibial nailing","volume":"36","author":"Gaines","year":"2013","journal-title":"Orthopedics"},{"issue":"5","key":"R44-20230901","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/BOT.0000000000000070","article-title":"Radiologic outcome and patient-reported function after intramedullary nailing: a comparison of the retropatellar and infrapatellar approach","volume":"28","author":"Jones","year":"2014","journal-title":"J Orthop Trauma"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01960901-201706000-00003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:38:49Z","timestamp":1787751529000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01960901-201706000-00003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,18]]},"references-count":44,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.16.00017","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4,18]]}}}