Posterolateral minimal incision, poking reduction, and simple internal fixation in treatment of collapsed fractures of posterolateral tibial plateau_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 TU Yonggang ^1,2 , REN Shaodong ² , YE Bolin ² , MA Bangxing ² , ZHANG Shifei ² , YUAN Haobin ²

1. Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
2. No.1 Department of Orthopedics, Changping Hospital of Dongguan, Dongguan Guangdong, 523573, P.R.China;

Corresponding author：

TU Yonggang, Email: 94665961@qq.com

Keywords：

Posterolateral tibial plateau fracture; collapsed fracture; poking reduction; internal fixation

DOI：

10.7507/1002-1892.201702037

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effectiveness of limited incision, poking reduction, and simple internal fixation in the treatment of collapsed fractures of the posterolateral tibial plateau. Methods Between October 2010 and January 2016, 16 patients with collapsed fractures of the posterolateral tibial plateau underwent posterolateral incision, poking reduction, and simple internal fixation. There were 10 males and 6 females with the age of 22-63 years (mean, 43.5 years). The injury was caused by falling in 5 cases, traffic accident in 7 cases, and falling from height in 4 cases. All cases had closed fractures. The left knee was involved in 9 cases and the right knee in 7 cases. The injury-to-admission time was 2 hours to 3 days (mean, 10 hours). X-ray films showed that the articular surface collapsing was more than 2 mm. According to Schatzker criteria, 6 cases were rated as type II and 10 cases as type III. Twelve cases had fracture of fibular head. The incision length, operation time, intraoperative blood loss, and incision healing were recorded; fracture healing was observed, and tibial plateau angle and posterior slope angle were measured on X-ray films; loss of articular surface reduction was observed by CT scan; and American Hospital for Special Surgery (HSS) score was used to evaluate the knee joint function. Results The incision length was 7-10 cm (mean, 8.6 cm); operation time was 35-55 minutes (mean, 46 minutes); intraoperative blood loss was 10-35 mL (mean, 28 mL). Primary healing of incision was obtained. Skin pain occurred in 1 case at 2 months because Kirschner wire retracted. Fifteen cases were followed up 8-21 months (mean, 13.5 months). The fracture healing time was from 3 to 6 months (mean, 4.8 months). There was no significant difference in tibial plateau angle and posterior slope angle between at immediate after operation and at last follow-up (t=–1.500, P=0.156; t=–1.781, P=0.097). The anatomic reduction rate of articular surface was 93.8% (15/16) at immediate after operation. At last follow-up, the recollapse height of articular surface was 0.1-1.2 mm (mean, 0.36 mm). According to the HSS score system, the results were excellent in 12 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 93.3%. Conclusion The limited incision by posterolateral approach, poking reduction, and simple internal fixation have the advantages of small injury, full exposure, and easy operation in the treatment of simple posterolateral tibial plateau fractures; bone graft support and simple internal fixation can prevent recollapse of the articular surface and achieve satisfactory knee function.

Citation： TU Yonggang, REN Shaodong, YE Bolin, MA Bangxing, ZHANG Shifei, YUAN Haobin. Posterolateral minimal incision, poking reduction, and simple internal fixation in treatment of collapsed fractures of posterolateral tibial plateau. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 810-814. doi: 10.7507/1002-1892.201702037 Copy

1.	Elsoe R, Larsen P, Nielsen NP, et al. Population-based epidemiology of tibial plateau fractures. Orthopedics, 2015, 38(9): e780-e786.
2.	Sferopoulos NK. Autograft transfer from the ipsilateral femoral condyle in depressed tibial plateau fracture. Open Orthop J, 2014, 8: 310-315.
3.	Zhai Q, Luo C, Zhu Y, et al. Morphological characteristics of split-depression fractures of the lateral tibial plateau (Schatzker type II): a computer-tomography-based study. Int Orthop, 2013, 37(5): 911-917.
4.	Xiang G, Zhi-Jun P, Qiang Z, et al. Morphological characteristics of posterolateral articular fragments in tibial plateau fractures. Orthopedics, 2013, 36(10): e1256-e1261.
5.	Tao J, Hang DH, Wang QG, et al. The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee, 2008, 15(6): 473-479.
6.	Chang SM. Selection of surgical approaches to the posterolateral tibial plateau fracture by its combination patterns. J Orthop Trauma, 2011, 25(3): e32-e33.
7.	夏江, 俞光荣, 周家钤, 等. 经后外侧入路治疗胫骨平台后外侧骨折的解剖学研究及应用. 中国临床解剖学杂志, 2010, 28(4): 369-374.
8.	Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Relat Res, 1988, (230): 83-97.
9.	罗东斌, 张永, 汤永南, 等. 双切口双钢板内固定与单侧锁定钢板内固定治疗复杂胫骨平台骨折的疗效比较. 中国老年学杂志, 2016, 36(6): 1413-1415.
10.	杨光辉, 杨太明, 朱裕成, 等. 胫骨平台后髁骨折的手术治疗. 中国矫形外科杂志, 2015, 23(14): 1272-1275.
11.	李煜, 刘玉民, 张宁, 等. 胫骨平台骨折 Schatzker 分型与膝关节功能相关性分析. 重庆医学, 2016, 45(12): 1629-1631.
12.	罗从风, 胡承方, 高洪, 等. 基于 CT 的胫骨平台骨折的三柱分型. 中华创伤骨科杂志, 2009, 11(3): 201-205.
13.	张峻, 张里程, 唐佩福. 胫骨平台后外侧髁骨折手术入路综述. 解放军医学院学报, 2016, 37(8): 905-907.
14.	胡孙君, 张世民, 张英琪, 等. 胫骨平台后外侧象限骨折手术入路的深层解剖及后外侧与后内侧比较. 中国临床解剖学杂志, 2015, 33(5): 497-501.
15.	Hu SJ, Chang SM, Zhang YQ, et al. The anterolateral supra-fibular-head approach for plating posterolateral tibial palteau fractures: A novel surgical technique. Injury, 2016, 47(2): 502-507.
16.	Chang SM, Zheng HP, Li HF, et al. Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg, 2009, 129(7): 955-962.
17.	李景光, 徐名洪, 黄爱民, 等. 有限切开撬拨复位三柱固定治疗复杂胫骨平台骨折. 中国矫形外科杂志, 2016, 24(6): 485-490.
18.	卓日波, 黄东, 黄国英, 等. 结构性异体骨移植治疗塌陷型胫骨平台骨折的效果. 广东医学, 2014, 35(23): 3678-3680.
19.	刘志祥, 李玉前, 王晓东, 等. 后外侧入路治疗单纯胫骨后外侧平台骨折. 江苏医药, 2015, 41(23): 2891-2892.
20.	陈奇, 徐晓峰, 黄永辉, 等. 膝关节囊外复位内固定治疗胫骨平台骨折的疗效观察. 中国修复重建外科杂志, 2014, 28(12): 1464-1468.

1. Elsoe R, Larsen P, Nielsen NP, et al. Population-based epidemiology of tibial plateau fractures. Orthopedics, 2015, 38(9): e780-e786.
2. Sferopoulos NK. Autograft transfer from the ipsilateral femoral condyle in depressed tibial plateau fracture. Open Orthop J, 2014, 8: 310-315.
3. Zhai Q, Luo C, Zhu Y, et al. Morphological characteristics of split-depression fractures of the lateral tibial plateau (Schatzker type II): a computer-tomography-based study. Int Orthop, 2013, 37(5): 911-917.
4. Xiang G, Zhi-Jun P, Qiang Z, et al. Morphological characteristics of posterolateral articular fragments in tibial plateau fractures. Orthopedics, 2013, 36(10): e1256-e1261.
5. Tao J, Hang DH, Wang QG, et al. The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee, 2008, 15(6): 473-479.
6. Chang SM. Selection of surgical approaches to the posterolateral tibial plateau fracture by its combination patterns. J Orthop Trauma, 2011, 25(3): e32-e33.
7. 夏江, 俞光荣, 周家钤, 等. 经后外侧入路治疗胫骨平台后外侧骨折的解剖学研究及应用. 中国临床解剖学杂志, 2010, 28(4): 369-374.
8. Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Relat Res, 1988, (230): 83-97.
9. 罗东斌, 张永, 汤永南, 等. 双切口双钢板内固定与单侧锁定钢板内固定治疗复杂胫骨平台骨折的疗效比较. 中国老年学杂志, 2016, 36(6): 1413-1415.
10. 杨光辉, 杨太明, 朱裕成, 等. 胫骨平台后髁骨折的手术治疗. 中国矫形外科杂志, 2015, 23(14): 1272-1275.
11. 李煜, 刘玉民, 张宁, 等. 胫骨平台骨折 Schatzker 分型与膝关节功能相关性分析. 重庆医学, 2016, 45(12): 1629-1631.
12. 罗从风, 胡承方, 高洪, 等. 基于 CT 的胫骨平台骨折的三柱分型. 中华创伤骨科杂志, 2009, 11(3): 201-205.
13. 张峻, 张里程, 唐佩福. 胫骨平台后外侧髁骨折手术入路综述. 解放军医学院学报, 2016, 37(8): 905-907.
14. 胡孙君, 张世民, 张英琪, 等. 胫骨平台后外侧象限骨折手术入路的深层解剖及后外侧与后内侧比较. 中国临床解剖学杂志, 2015, 33(5): 497-501.
15. Hu SJ, Chang SM, Zhang YQ, et al. The anterolateral supra-fibular-head approach for plating posterolateral tibial palteau fractures: A novel surgical technique. Injury, 2016, 47(2): 502-507.
16. Chang SM, Zheng HP, Li HF, et al. Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg, 2009, 129(7): 955-962.
17. 李景光, 徐名洪, 黄爱民, 等. 有限切开撬拨复位三柱固定治疗复杂胫骨平台骨折. 中国矫形外科杂志, 2016, 24(6): 485-490.
18. 卓日波, 黄东, 黄国英, 等. 结构性异体骨移植治疗塌陷型胫骨平台骨折的效果. 广东医学, 2014, 35(23): 3678-3680.
19. 刘志祥, 李玉前, 王晓东, 等. 后外侧入路治疗单纯胫骨后外侧平台骨折. 江苏医药, 2015, 41(23): 2891-2892.
20. 陈奇, 徐晓峰, 黄永辉, 等. 膝关节囊外复位内固定治疗胫骨平台骨折的疗效观察. 中国修复重建外科杂志, 2014, 28(12): 1464-1468.

Chinese Journal of Reparative and Reconstructive Surgery

Posterolateral minimal incision, poking reduction, and simple internal fixation in treatment of collapsed fractures of posterolateral tibial plateau

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content