MODIFIED POSTEROLATERAL COUNTER-CURVED INCISION WITH DOUBLE INTERMUSCULAR APPROACH IN TREATING POSTEROLATERAL TIBIAL PLATEAU FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZONGShuangle , SULixin , LILigeng , LIANGWeidong , ZHAOXiaoming , WANGAijun , LILidong

Department of Orthopaedics, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China;

Corresponding author：

ZONGShuangle, Email: zongshuangle@163.com

Keywords：

Tibia plateau fracture; Posterolateral approach; Internal fixation

DOI：

10.7507/1002-1892.20160219

Video：

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Objective To evaluate the effectiveness of the modified posterolateral counter-curved incision with double intermuscular approach for the treatment of posterolateral tibial plateau fractures. Methods A retrospective analysis was made on the clinical data of 32 patients with posterolateral tibial plateau fractures between September 2012 and October 2014. There were 22 males and 10 females, aged 19 to 55 years (mean, 40.5 years). The causes of injury included traffic accident in 17 cases, falling from height in 9 cases, and falling in 6 cases. They had fresh closed fracture; injury to hospitalization time was 3 hours to 5 days (mean, 2 days). According to Schatzker tibial plateau fracture classification criteria, 20 cases were rated as type II, and 12 cases as type III. All patients underwent a modified posterolateral counter-curved incision with double intermuscular approach to expose tibial posterolateral condyle and anterolateral condyle. After a good visual control of fracture reduction, the anterolateral and posterolateral fractures were fixed with two-dimensional buttress plate respectively. Results The incisions healed at stage I, with no major neurovascular injury. According to radiological assessment of the DeCoster score, the results were excellent in 21 cases, and fair in 11 cases. All of the 32 patients were followed up 18 to 30 months (mean, 20.5 months). The X-ray films showed that all patients obtained good fracture union, and the mean time of fracture union was 12.3 weeks (range, 10-16 weeks). No fixation failure or no obvious loss of articular surface reduction was observed during follow-up. The range of motion of the affected knees was 2-135° (mean, 120°). The mean American Hospital for Special Surgery (HSS) score was 90.05 (range, 83-96) at 18 months after operation. Conclusion The modified posterolateral counter-curved incision with double intermuscular approach could fully expose posterolateral tibia plateau, and good fracture reduction and reliable fixation can be obtained under direct vision.

Citation： ZONGShuangle, SULixin, LILigeng, LIANGWeidong, ZHAOXiaoming, WANGAijun, LILidong. MODIFIED POSTEROLATERAL COUNTER-CURVED INCISION WITH DOUBLE INTERMUSCULAR APPROACH IN TREATING POSTEROLATERAL TIBIAL PLATEAU FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1076-1080. doi: 10.7507/1002-1892.20160219 Copy

1.	Partenheimer A, Gösling T, Müller M, et al. Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation. Unfallchirurg, 2007, 110(8):675-683.
2.	Bhattacharyya T, McCarty LP 3rd, Harris MB, et al. The posterior shearing tibial plateau fracture:treatment and results via a posterior approach. J Orthop Trauma, 2005, 19(5):305-310.
3.	Lobenhoffer P, Gerich T, Bertram T, et al. Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg, 1997, 100(12):957-967.
4.	罗从风, 姜锐, 仲飙, 等.经后侧入路支撑钢板固定治疗胫骨平台后侧劈裂骨折.中华创伤骨科杂志, 2007, 9(1):6-9.
5.	陶杰, 杭栋华, 王秋根, 等.改良侧后方入路治疗胫骨平台后方剪力骨折.中国矫形外科杂志, 2008, 16(24):1863-1866.
6.	俞光荣, 夏江, 周家钤, 等.经后外侧入路治疗胫骨平台单纯后外侧骨折.中华外科杂志, 2010, 48(5):390-392.
7.	庄岩, 王鹏飞, 张堃, 等.经腓骨截骨入路治疗胫骨平台后外侧骨折的疗效观察.中华骨科杂志, 2012, 32(8):732-738.
8.	Liu GY, Xiao BP, Luo CF, et al. Results of a modified posterolateral approach for the isolated posterolateral tibial plateau fracture. Indian J Orthop, 2016, 50(2):117-122.
9.	朱海涛, 王文跃, 王俭, 等.外后侧弧形切口双肌间隙入路治疗胫骨后外侧平台塌陷骨折.中华骨科杂志, 2014, 34(7):703-708.
10.	Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, (138):94-104.
11.	Sun H, Luo CF, Yang G, et al. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol, 2013, 23(7):809-818.
12.	DeCoster TA, Willis MC, Marsh JL, et al. Rank order analysis of tibial plafond fractures:does injury or reduction predict outcome? Foot Ankle Int, 1999, 20(1):44-49.
13.	Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11):683-692.
14.	Patange Subba Rao SP, Lewis J, Haddad Z, et al. Three-column classification and Schatzker classification:a three-and two-dimensional computed tomography characterisation and analysis of tibial plateau fractures. Eur J Orthop Surg Traumatol, 2014, 24(7):1263-1270.
15.	Yoon R, Liporace FA, Egol KA. Definitive fixation of tibial plateau fractures. Orthop Clin North Am, 2015, 46(3):363-375.
16.	Frosch KH, Balcarek P, Walde T, et al. A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma, 2010, 24(8):515-520.
17.	Zhang W, Luo CF, Putnis S, et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee, 2012, 19(2):94-98.
18.	Yu B, Han K, Zhan C, et al. Fibular head osteotomy:a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee, 2010, 17(5):313-318.
19.	陈红卫, 张根福, 潘俊, 等.改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折.中华骨科杂志, 2013, 33(9):935-940.

1. Partenheimer A, Gösling T, Müller M, et al. Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation. Unfallchirurg, 2007, 110(8):675-683.
2. Bhattacharyya T, McCarty LP 3rd, Harris MB, et al. The posterior shearing tibial plateau fracture:treatment and results via a posterior approach. J Orthop Trauma, 2005, 19(5):305-310.
3. Lobenhoffer P, Gerich T, Bertram T, et al. Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg, 1997, 100(12):957-967.
4. 罗从风, 姜锐, 仲飙, 等.经后侧入路支撑钢板固定治疗胫骨平台后侧劈裂骨折.中华创伤骨科杂志, 2007, 9(1):6-9.
5. 陶杰, 杭栋华, 王秋根, 等.改良侧后方入路治疗胫骨平台后方剪力骨折.中国矫形外科杂志, 2008, 16(24):1863-1866.
6. 俞光荣, 夏江, 周家钤, 等.经后外侧入路治疗胫骨平台单纯后外侧骨折.中华外科杂志, 2010, 48(5):390-392.
7. 庄岩, 王鹏飞, 张堃, 等.经腓骨截骨入路治疗胫骨平台后外侧骨折的疗效观察.中华骨科杂志, 2012, 32(8):732-738.
8. Liu GY, Xiao BP, Luo CF, et al. Results of a modified posterolateral approach for the isolated posterolateral tibial plateau fracture. Indian J Orthop, 2016, 50(2):117-122.
9. 朱海涛, 王文跃, 王俭, 等.外后侧弧形切口双肌间隙入路治疗胫骨后外侧平台塌陷骨折.中华骨科杂志, 2014, 34(7):703-708.
10. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, (138):94-104.
11. Sun H, Luo CF, Yang G, et al. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol, 2013, 23(7):809-818.
12. DeCoster TA, Willis MC, Marsh JL, et al. Rank order analysis of tibial plafond fractures:does injury or reduction predict outcome? Foot Ankle Int, 1999, 20(1):44-49.
13. Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11):683-692.
14. Patange Subba Rao SP, Lewis J, Haddad Z, et al. Three-column classification and Schatzker classification:a three-and two-dimensional computed tomography characterisation and analysis of tibial plateau fractures. Eur J Orthop Surg Traumatol, 2014, 24(7):1263-1270.
15. Yoon R, Liporace FA, Egol KA. Definitive fixation of tibial plateau fractures. Orthop Clin North Am, 2015, 46(3):363-375.
16. Frosch KH, Balcarek P, Walde T, et al. A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma, 2010, 24(8):515-520.
17. Zhang W, Luo CF, Putnis S, et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee, 2012, 19(2):94-98.
18. Yu B, Han K, Zhan C, et al. Fibular head osteotomy:a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee, 2010, 17(5):313-318.
19. 陈红卫, 张根福, 潘俊, 等.改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折.中华骨科杂志, 2013, 33(9):935-940.

Chinese Journal of Reparative and Reconstructive Surgery

MODIFIED POSTEROLATERAL COUNTER-CURVED INCISION WITH DOUBLE INTERMUSCULAR APPROACH IN TREATING POSTEROLATERAL TIBIAL PLATEAU FRACTURES

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