Application of reverse traction device in preoperative treatment of high-energy tibial plateau fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Mingli ¹ , CHEN Zonglin ¹ , LI Honghan ¹ , CHEN Jinhong ¹ , GAO Hongpeng ² , HUANG Miao ² , XUE Guanqi ² , LIN Zepeng ² ,  YANG Rongyuan ¹

1. Department of Orthopedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P. R. China;
2. School of Clinical Medicine, Fujian Medical University, Fuzhou Fujian, 350004, P. R. China;

Corresponding author：

YANG Rongyuan, Email: 848704282@qq.com

Keywords：

Tibial plateau fracture; reverse traction; calcaneal traction; comfortable level

DOI：

10.7507/1002-1892.202404004

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Objective To investigate the effectiveness of the reverse traction device in the preoperative treatment of high-energy tibial plateau fractures. Methods A retrospective study was conducted to analyze the clinical data of 33 patients with high-energy tibial plateau fractures who met the selection criteria between December 2020 and December 2023. All patients were treated by open reduction and internal fixation. According to the preoperative traction method, they were divided into the observation group (16 cases, treated with a reverse traction device on the day of admission) and the control group (17 cases, treated with heel traction on the day of admission). There was no significant difference in baseline data such as gender, age, body mass index, affected side, cause of injury, fracture Schatzker classification between the two groups (P>0.05). Preoperative waiting time, preoperative related complications (nail channel loosening, nail channel oozing, nail channel infection, soft tissue necrosis, soft tissue infection, deep vein thrombosis of the lower extremity, etc.), operation time, and total hospitalization time were recorded and compared between the two groups. On the 4th day after traction, visual analogue scale (VAS) score was used to evaluate the pain relief of the patients, the swelling value of the affected limb was measured, and the Immobilization Comfort Questionnaire (ICQ) score was used to evaluate the perioperative hospital comfort of the patients. Results Both groups of patients completed the operation successfully, and the operation time, total hospitalization time, and preoperative waiting time of the observation group were significantly less than those of the control group (P<0.05). There was no preoperative related complications in the observation group; in the control group, 3 patients had nail channel loosening and oozing, and 2 cases had the deep vein thrombosis of the lower extremity; the difference in the incidence of complication between the two groups was significant (P<0.05). On the 4th day after traction, the ICQ score, VAS score, and limb swelling value of the observation group were significantly better than those of the control group (P<0.05). X-ray films showed that the tibial plateau fracture separation and lower limb alignment recovered after calcaneal traction in the control group, but not as obvious as in the observation group. The fracture gap in the observation group significantly reduced, the tibial plateau alignment was good, and the lateral angulation deformity was corrected. Conclusion The use of reverse traction treatment in patients with high-energy tibial plateau fractures on admission can accelerate the swelling around the soft tissues to subside, reduce patients’ pain, shorten the preoperative waiting time, improve the patients’ preoperative quality of life, and contribute to the shortening of the operation time, with a good effectiveness.

Citation： CHEN Mingli, CHEN Zonglin, LI Honghan, CHEN Jinhong, GAO Hongpeng, HUANG Miao, XUE Guanqi, LIN Zepeng, YANG Rongyuan. Application of reverse traction device in preoperative treatment of high-energy tibial plateau fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(7): 830-835. doi: 10.7507/1002-1892.202404004 Copy

1.	宇文培之, 李栋正, 吕红芝, 等. 2009年至2018年河北医科大学第三医院胫骨平台骨折流行病学调查. 中华创伤骨科杂志, 2019, 21(8): 693-698.
2.	田野, 王娟, 陈伟, 等. 2003年至2012年河北医科大学第三医院成人胫骨平台骨折的流行病学分析. 中华创伤骨科杂志, 2015, 17(5): 424-427.
3.	Bormann M, Neidlein C, Gassner C, et al. Changing patterns in the epidemiology of tibial plateau fractures: a 10-year review at a level-Ⅰ trauma center. Eur J Trauma Emerg Surg, 2023, 49(1): 401-409.
4.	Herteleer M, Van Brandt C, Vandoren C, et al. Tibial plateau fractures in Belgium: epidemiology, financial burden and costs curbing strategies. Eur J Trauma Emerg Surg, 2022, 48(5): 3643-3650.
5.	Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968—1975. Clin Orthop Relat Res, 1979, (138): 94-104.
6.	Franulic N, Brito C, Del Pino C, et al. The use of arthroscopy does not increase the incidence of complications in the management of Schatzker Ⅳ-Ⅵ tibial plateau fractures. Rev Esp Cir Ortop Traumatol, 2023, 67(4): T290-T296.
7.	Flagstad I, Albright P, Pedri T, et al. Early versus delayed definitive fixation relative to fasciotomy closure in high-energy tibial plateau fractures with compartment syndrome. J Orthop Trauma, 2024, 38(6): 195-200.
8.	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.
9.	Gahr P, Mittlmeier T, Grau A, et al. Functional assessment and outcome following surgical treatment of displaced tibial plateau fractures: a retrospective analysis. Eur J Trauma Emerg Surg, 2023, 49(6): 2373-2379.
10.	张英泽. 胫骨平台骨折诊疗创新与发展再探索. 中华创伤骨科杂志, 2020, 22(8): 662-664.
11.	Yang JZ, Zhu WB, Li LB, et al. Early complications of preoperative external traction fixation in the staged treatment of tibial fractures: A series of 402 cases. World J Clin Cases, 2020, 8(20): 4743-4752.
12.	Tosun B, Aslan Ö, Tunay S, et al. Turkish version of kolcaba’s immobilization comfort questionnaire: A validity and reliability study. Asian Nurs Res (Korean Soc Nurs Sci), 2015, 9(4): 278-284.
13.	Thomas TP, Anderson DD, Mosqueda TV, et al. Objective CT-based metrics of articular fracture severity to assess risk for posttraumatic osteoarthritis. J Orthop Trauma, 2010, 24(12): 764-769.
14.	Naja AS, Bouji N, Eddine MN, et al. A meta-analysis comparing external fixation against open reduction and internal fixation for the management of tibial plateau fractures. Strategies Trauma Limb Reconstr, 2022, 17(2): 105-116.
15.	Hansen L, Larsen P, Elsoe R. Characteristics of patients requiring early total knee replacement after surgically treated lateral tibial plateau fractures—A comparative cohort study. Eur J Orthop Surg Traumatol, 2022, 32(6): 1097-1103.
16.	Makaram NS, Param A, Clement ND, et al. Primary versus secondary total knee arthroplasty for tibial plateau fractures in patients aged 55 or over—A systematic review and meta-analysis. J Arthroplasty, 2024, 39(2): 559-567.
17.	Tuncez M, Akan I, Seyfettinoğlu F, et al. Is it necessary to add soft tissue injury to the classification in tibial plateau fracture management? Cureus, 2022, 14(2): e22236. doi: 10.7759/cureus.22236.
18.	Mills WJ, Nork SE. Open reduction and internal fixation of high-energy tibial plateau fractures. Orthop Clin North Am, 2002, 33(1): 177-198.
19.	洪顾麒, 吕天润, 陈群, 等. 分阶段治疗伴严重软组织损伤的复杂胫骨平台骨折近期疗效. 中国修复重建外科杂志, 2022, 36(10): 1249-1254.
20.	李卉, 周武, 曹发奇, 等. 加速康复外科理念在双反牵引微创治疗胫骨平台骨折中的应用研究. 中华创伤骨科杂志, 2021, 23(10): 911-915.
21.	黄屾, 周智勋, 周道广, 等. 双反牵引复位对下肢骨折患者住院期间下肢深静脉血栓形成的影响. 血管与腔内血管外科杂志, 2023, 9(7): 855-858, 880.

1. 宇文培之, 李栋正, 吕红芝, 等. 2009年至2018年河北医科大学第三医院胫骨平台骨折流行病学调查. 中华创伤骨科杂志, 2019, 21(8): 693-698.
2. 田野, 王娟, 陈伟, 等. 2003年至2012年河北医科大学第三医院成人胫骨平台骨折的流行病学分析. 中华创伤骨科杂志, 2015, 17(5): 424-427.
3. Bormann M, Neidlein C, Gassner C, et al. Changing patterns in the epidemiology of tibial plateau fractures: a 10-year review at a level-Ⅰ trauma center. Eur J Trauma Emerg Surg, 2023, 49(1): 401-409.
4. Herteleer M, Van Brandt C, Vandoren C, et al. Tibial plateau fractures in Belgium: epidemiology, financial burden and costs curbing strategies. Eur J Trauma Emerg Surg, 2022, 48(5): 3643-3650.
5. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968—1975. Clin Orthop Relat Res, 1979, (138): 94-104.
6. Franulic N, Brito C, Del Pino C, et al. The use of arthroscopy does not increase the incidence of complications in the management of Schatzker Ⅳ-Ⅵ tibial plateau fractures. Rev Esp Cir Ortop Traumatol, 2023, 67(4): T290-T296.
7. Flagstad I, Albright P, Pedri T, et al. Early versus delayed definitive fixation relative to fasciotomy closure in high-energy tibial plateau fractures with compartment syndrome. J Orthop Trauma, 2024, 38(6): 195-200.
8. 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.
9. Gahr P, Mittlmeier T, Grau A, et al. Functional assessment and outcome following surgical treatment of displaced tibial plateau fractures: a retrospective analysis. Eur J Trauma Emerg Surg, 2023, 49(6): 2373-2379.
10. 张英泽. 胫骨平台骨折诊疗创新与发展再探索. 中华创伤骨科杂志, 2020, 22(8): 662-664.
11. Yang JZ, Zhu WB, Li LB, et al. Early complications of preoperative external traction fixation in the staged treatment of tibial fractures: A series of 402 cases. World J Clin Cases, 2020, 8(20): 4743-4752.
12. Tosun B, Aslan Ö, Tunay S, et al. Turkish version of kolcaba’s immobilization comfort questionnaire: A validity and reliability study. Asian Nurs Res (Korean Soc Nurs Sci), 2015, 9(4): 278-284.
13. Thomas TP, Anderson DD, Mosqueda TV, et al. Objective CT-based metrics of articular fracture severity to assess risk for posttraumatic osteoarthritis. J Orthop Trauma, 2010, 24(12): 764-769.
14. Naja AS, Bouji N, Eddine MN, et al. A meta-analysis comparing external fixation against open reduction and internal fixation for the management of tibial plateau fractures. Strategies Trauma Limb Reconstr, 2022, 17(2): 105-116.
15. Hansen L, Larsen P, Elsoe R. Characteristics of patients requiring early total knee replacement after surgically treated lateral tibial plateau fractures—A comparative cohort study. Eur J Orthop Surg Traumatol, 2022, 32(6): 1097-1103.
16. Makaram NS, Param A, Clement ND, et al. Primary versus secondary total knee arthroplasty for tibial plateau fractures in patients aged 55 or over—A systematic review and meta-analysis. J Arthroplasty, 2024, 39(2): 559-567.
17. Tuncez M, Akan I, Seyfettinoğlu F, et al. Is it necessary to add soft tissue injury to the classification in tibial plateau fracture management? Cureus, 2022, 14(2): e22236. doi: 10.7759/cureus.22236.
18. Mills WJ, Nork SE. Open reduction and internal fixation of high-energy tibial plateau fractures. Orthop Clin North Am, 2002, 33(1): 177-198.
19. 洪顾麒, 吕天润, 陈群, 等. 分阶段治疗伴严重软组织损伤的复杂胫骨平台骨折近期疗效. 中国修复重建外科杂志, 2022, 36(10): 1249-1254.
20. 李卉, 周武, 曹发奇, 等. 加速康复外科理念在双反牵引微创治疗胫骨平台骨折中的应用研究. 中华创伤骨科杂志, 2021, 23(10): 911-915.
21. 黄屾, 周智勋, 周道广, 等. 双反牵引复位对下肢骨折患者住院期间下肢深静脉血栓形成的影响. 血管与腔内血管外科杂志, 2023, 9(7): 855-858, 880.

Chinese Journal of Reparative and Reconstructive Surgery

Application of reverse traction device in preoperative treatment of high-energy tibial plateau fracture

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