Application of a new universal locking anatomical plate in treatment of tibial plateau posterolateral column fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LAN Wenbin , LIN Peisen , WANG Fasheng , WU Gui , QIU Yaoyu ,  XIE Yun

Department of Orthopedic Trauma & Ankle Surgery, Fujian Trauma Medical Center, First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350004, P. R. China;

Corresponding author：

XIE Yun, Email: xieyun0591@outkook.com

Keywords：

Tibial plateau fracture; posterolateral column; open reduction; internal fixation; universal locking anatomical plate

DOI：

10.7507/1002-1892.202207093

Video：

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Objective To investigate the effectiveness of a new tibial plateau posterolateral column universal locking anatomical plate (hereinafter referred to as “new universal locking anatomical plate”) in the treatment of tibial plateau posterolateral column fractures. Methods Between October 2020 and December 2021, 14 patients with tibial plateau posterolateral column fracture were treated with a new universal locking anatomical plate. There were 7 males and 7 females with an average age of 59 years ranging from 29 to 75 years. There were 5 cases on the left side and 9 cases on the right side. The causes of injury included falling from height in 5 cases, traffic accident in 7 cases, and other injuries in 2 cases. The time from injury to operation ranged from 3 to 10 days, with an average of 6 days. According to Schatzker classification, there were 4 cases of type Ⅱ, 8 cases of type Ⅴ, and 2 cases of type Ⅵ. All fractures involved the posterolateral tibial plateau. Three column classification: two columns (anterolateral column+posterior column) in 4 cases, three columns in 10 cases. The operation time, intraoperative blood loss, fracture healing, and complications were recorded. The reduction of tibial plateau fracture was evaluated by Rasmussen radiographic score, and the recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score. Results All 14 cases completed the operation successfully. The operation time was 95-180 minutes, with an average of 154 minutes, and the intraoperative blood loss was 100-480 mL, with an average of 260 mL. All patients were followed up 6-19 months, with an average of 12.5 months. All fractures healed, and the healing time was 15-24 weeks, with an average of 18.7 weeks. During the follow-up, there was 1 case of common peroneal nerve palsy and 1 case of traumatic osteoarthritis. There was no other complication such as vascular injury, incision infection, deep venous thrombosis of lower limbs, heterotopic ossification, bone nonunion, and failure of internal fixation. The reduction of tibial plateau fractures was good immediately after operation, and the Rasmussen radiological score was 10-18, with an average of 15.7; 3 cases were excellent, 10 cases were good, and 1 case was fair, with an excellent and good rate of 92.9%. The scores and grades of HSS at 3 months after operation and at last follow-up significantly improved when compared with those before operation (P<0.05). There was no significant difference between 3 months after operation and last follow-up (P>0.05).Conclusion For the fractures involving the posterolateral column of the tibial plateau, the new universal locking anatomical plate can provide strong fixation, satisfactory postoperative fracture reduction, and good recovery of knee function.

Citation： LAN Wenbin, LIN Peisen, WANG Fasheng, WU Gui, QIU Yaoyu, XIE Yun. Application of a new universal locking anatomical plate in treatment of tibial plateau posterolateral column fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(11): 1351-1356. doi: 10.7507/1002-1892.202207093 Copy

1.	Kfuri M, Schatzker J. Revisiting the Schatzker classification of tibial plateau fractures. Injury, 2018, 49(12): 2252-2263.
2.	Wang Y, Luo C, Zhu Y, et al. Updated three-column concept in surgical treatment for tibial plateau fractures—A prospective cohort study of 287 patients. Injury, 2016, 47(7): 1488-1496.
3.	Van den Berg J, De Boer AS, Assink N, et al. Trauma mechanism and patient reported outcome in tibial plateau fractures with posterior involvement. Knee, 2021, 30: 41-50.
4.	Quintens L, Van den Berg J, Reul M, et al. Poor sporting abilities after tibial plateau fractures involving the posterior column: how can we do better? Eur J Trauma Emerg Surg, 2021, 47(1): 201-209.
5.	Cai P, Yuan M, Ji H, et al. The treatment of posterolateral tibial plateau fracture with a newly designed anatomical plate via the trans-supra-fibular head approach: preliminary outcomes. BMC Musculoskelet Disord, 2021, 22(1): 804. doi: 10.1186/s12891-021-04684-w.
6.	Yin Z, Yang W, Gu Y, et al. A modified direct posterior midline approach for the treatment of posterior column tibial plateau fractures. J Knee Surg, 2020, 33(7): 646-654.
7.	Yi Z, Hui S, Binbin Z, et al. A new strategy to fix posterolateral depression in tibial plateau fractures: Introduction of a new modified Frosch approach and a “Barrel hoop plate” technique. Injury, 2020, 51(3): 723-734.
8.	Kim Y, Yoon YC, Cho JW, et al. Rim plate augmentation of the posterolateral bare area of the tibial plateau using a 3.5-mm precontoured locking compression plate:A cadaveric study. J Orthop Trauma, 2018, 32(5): e157-e160.
9.	Sun H, He QF, Zhang BB, et al. A biomechanical evaluation of different fixation strategies for posterolateral fragments in tibial plateau fractures and introduction of the ‘magic screw’. Knee, 2018, 25(3): 417-426.
10.	Giordano V, Schatzker J, Kfuri M. The “hoop” plate for posterior bicondylar shear tibial plateau fractures: Description of a new surgical technique. J Knee Surg, 2017, 30(6): 509-513.
11.	王海, 谢昀, 林章雄, 等. 扩大Carlson切口钢板内固定治疗胫骨后外侧平台合并前外侧平台骨折. 中华创伤杂志, 2020, 36(10): 905-911.
12.	Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg (Am), 1973, 55(7): 1331-1350.
13.	袁亮, 吕扬, 周方, 等. 胫骨平台骨折手术疗效三种评价体系相关性研究. 中华创伤骨科杂志, 2017, 19(4): 349-352.
14.	刘忠玉, 张金利, 刘培佳, 等. 复杂过伸型胫骨平台骨折的形态特征及手术策略. 中华骨科杂志, 2021, 41(5): 289-296.
15.	Shen QJ, Zhang JL, Xing GS, et al. Surgical treatment of lateral tibial plateau fractures involving the posterolateral column. Orthop Surg, 2019, 11(6): 1029-1038.
16.	Foster B, Rodriguez-Buitrago A, Obremskey WT. Prone posteromedial approach for posterior column tibial plateau fractures. J Orthop Trauma, 2020, 34(Suppl2): S35-S36.
17.	Tarng YW, Lin KC. A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury. Injury, 2019, 50(10): 1756-1763.
18.	Zheng Y, Zhang JD, Shen JJ, et al. “Out-in” position in the surgical treatment of three-column tibial plateau fractures: A technical note. Injury, 2021, 52(4): 1074-1078.
19.	Chouhan DK, Dhillon MS, Puneeth K, et al. Gastrocnemius raphe split approach for complex proximal tibia fractures—Applicability and advantages. Injury, 2018, 49(12): 2269-2274.
20.	Orapiriyakul W, Apivatthakakul T, Phornphutkul C. Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study. Arch Orthop Trauma Surg, 2018, 138(4): 505-513.
21.	Ramponi DR, McSwigan T. Tibial plateau fractures. Adv Emerg Nurs J, 2018, 40(3): 155-161.
22.	Sabatini L, Aprato A, Camazzola D, et al. Primary total knee arthroplasty in tibial plateau fractures: Literature review and our institutional experience. Injury, 2021. doi: 10.1016/j.injury.2021.02.006.
23.	Stevenson I, McMillan TE, Baliga S, et al. Primary and secondary total knee arthroplasty for tibial plateau fractures. J Am Acad Orthop Surg, 2018, 26(11): 386-395.
24.	Pattyn R, Loder R, Mullis BH. Iatrogenic peroneal nerve palsy rates secondary to open reduction internal fixation for tibial plateau fractures using an intraoperative distractor. J Orthop Trauma, 2020, 34(7): 359-362.

1. Kfuri M, Schatzker J. Revisiting the Schatzker classification of tibial plateau fractures. Injury, 2018, 49(12): 2252-2263.
2. Wang Y, Luo C, Zhu Y, et al. Updated three-column concept in surgical treatment for tibial plateau fractures—A prospective cohort study of 287 patients. Injury, 2016, 47(7): 1488-1496.
3. Van den Berg J, De Boer AS, Assink N, et al. Trauma mechanism and patient reported outcome in tibial plateau fractures with posterior involvement. Knee, 2021, 30: 41-50.
4. Quintens L, Van den Berg J, Reul M, et al. Poor sporting abilities after tibial plateau fractures involving the posterior column: how can we do better? Eur J Trauma Emerg Surg, 2021, 47(1): 201-209.
5. Cai P, Yuan M, Ji H, et al. The treatment of posterolateral tibial plateau fracture with a newly designed anatomical plate via the trans-supra-fibular head approach: preliminary outcomes. BMC Musculoskelet Disord, 2021, 22(1): 804. doi: 10.1186/s12891-021-04684-w.
6. Yin Z, Yang W, Gu Y, et al. A modified direct posterior midline approach for the treatment of posterior column tibial plateau fractures. J Knee Surg, 2020, 33(7): 646-654.
7. Yi Z, Hui S, Binbin Z, et al. A new strategy to fix posterolateral depression in tibial plateau fractures: Introduction of a new modified Frosch approach and a “Barrel hoop plate” technique. Injury, 2020, 51(3): 723-734.
8. Kim Y, Yoon YC, Cho JW, et al. Rim plate augmentation of the posterolateral bare area of the tibial plateau using a 3.5-mm precontoured locking compression plate:A cadaveric study. J Orthop Trauma, 2018, 32(5): e157-e160.
9. Sun H, He QF, Zhang BB, et al. A biomechanical evaluation of different fixation strategies for posterolateral fragments in tibial plateau fractures and introduction of the ‘magic screw’. Knee, 2018, 25(3): 417-426.
10. Giordano V, Schatzker J, Kfuri M. The “hoop” plate for posterior bicondylar shear tibial plateau fractures: Description of a new surgical technique. J Knee Surg, 2017, 30(6): 509-513.
11. 王海, 谢昀, 林章雄, 等. 扩大Carlson切口钢板内固定治疗胫骨后外侧平台合并前外侧平台骨折. 中华创伤杂志, 2020, 36(10): 905-911.
12. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg (Am), 1973, 55(7): 1331-1350.
13. 袁亮, 吕扬, 周方, 等. 胫骨平台骨折手术疗效三种评价体系相关性研究. 中华创伤骨科杂志, 2017, 19(4): 349-352.
14. 刘忠玉, 张金利, 刘培佳, 等. 复杂过伸型胫骨平台骨折的形态特征及手术策略. 中华骨科杂志, 2021, 41(5): 289-296.
15. Shen QJ, Zhang JL, Xing GS, et al. Surgical treatment of lateral tibial plateau fractures involving the posterolateral column. Orthop Surg, 2019, 11(6): 1029-1038.
16. Foster B, Rodriguez-Buitrago A, Obremskey WT. Prone posteromedial approach for posterior column tibial plateau fractures. J Orthop Trauma, 2020, 34(Suppl2): S35-S36.
17. Tarng YW, Lin KC. A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury. Injury, 2019, 50(10): 1756-1763.
18. Zheng Y, Zhang JD, Shen JJ, et al. “Out-in” position in the surgical treatment of three-column tibial plateau fractures: A technical note. Injury, 2021, 52(4): 1074-1078.
19. Chouhan DK, Dhillon MS, Puneeth K, et al. Gastrocnemius raphe split approach for complex proximal tibia fractures—Applicability and advantages. Injury, 2018, 49(12): 2269-2274.
20. Orapiriyakul W, Apivatthakakul T, Phornphutkul C. Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study. Arch Orthop Trauma Surg, 2018, 138(4): 505-513.
21. Ramponi DR, McSwigan T. Tibial plateau fractures. Adv Emerg Nurs J, 2018, 40(3): 155-161.
22. Sabatini L, Aprato A, Camazzola D, et al. Primary total knee arthroplasty in tibial plateau fractures: Literature review and our institutional experience. Injury, 2021. doi: 10.1016/j.injury.2021.02.006.
23. Stevenson I, McMillan TE, Baliga S, et al. Primary and secondary total knee arthroplasty for tibial plateau fractures. J Am Acad Orthop Surg, 2018, 26(11): 386-395.
24. Pattyn R, Loder R, Mullis BH. Iatrogenic peroneal nerve palsy rates secondary to open reduction internal fixation for tibial plateau fractures using an intraoperative distractor. J Orthop Trauma, 2020, 34(7): 359-362.

Chinese Journal of Reparative and Reconstructive Surgery

Application of a new universal locking anatomical plate in treatment of tibial plateau posterolateral column fractures

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