AN IMPROVED REDUCTION TECHNIQUE FOR DEPRESSION FRACTURES OF LATERAL TIBIAL PLATEAU_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Hongchuan , LOU Hua , LIU Kai , JIANG Junwei.

Department of Orthopedics, People’s Hospital of Leshan, Leshan Sichuan, 614000, P.R.China. Corresponding author: JIANG Junwei, E-mail: 285061643@qq.com;

Corresponding author：

Keywords：

Tibial plateau fracture; Articular surface collapse; Articular surface reduction; Internal fixation

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Objective To investigate the improved reduction technique for depression fractures of the lateral tibial plateau and its effectiveness. Methods Between January 2008 and December 2010, 48 patients (48 knees) with depression fractures of the lateral tibial plateau (Schatzker II or III fractures) were treated. There were 32 males and 16 females with an average age of 45.8 years (range, 16-79 years). All fractures were fresh closed fractures, which were caused by traffic accident in 27 cases, by falling from height in 5 cases, by crushing in 8 cases, and by sustained falls in 8 cases. According to Schatzker classification, 29 cases were classified as type II and 19 cases as type III. The lateral cortex was cut off to expose the depression and compacted cancellous bone was elevated to reset the articular surface. After reduction, autologous iliac bone graft and locking plate internal fixation were used. Results Healing of incision by first intention was achieved in all patients, and no complication occurred. All patients were followed up 1.7 years on average (range, 1-3 years). At last follow-up, the knee extension was ( — 0.5 ± 0.3)°, and the knee flexion was (136.9 ± 8.8)°. X-ray films showed that the fracture healing time was 52 weeks and no breakage of internal fixation occurred. According to Rasmussen clinical score, the results were excellent in 35 cases, good in 10 cases, and fair in 3 cases. According to Rasmussen radiographical score, the results were excellent in 41 cases, good in 7 cases; there were 41 excellent scores and 7 good scores of articular reduction; all gained good recovery of coronal and sagittal alignment and condylar width. The articular surface collapse was (1.0 ± 0.7) mm at immediate postoperatively and (1.2 ± 0.7) mm at last follow-up, showing no significant difference (t= — 1.42, P=0.20), but significant differences were found when compared with that at preoperation [(12.2 ± 8.0) mm, P lt; 0.05]. Conclusion This improved technique can provide a satisfactory effectiveness of fracture reduction and can avoid loss of reduction. The short-term effectiveness is good, but futher follow-up is necessary to determine the long-term results.

Citation： WANG Hongchuan,LOU Hua,LIU Kai,JIANG Junwei.. AN IMPROVED REDUCTION TECHNIQUE FOR DEPRESSION FRACTURES OF LATERAL TIBIAL PLATEAU. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(1): 12-16. doi: Copy

1.	Keating JF, Hajducka CL, Harper J. Minimal internal fixation and calcium-phosphate cement in the treatment of fractures of the tibial plateau. A pilot study. J Bone Joint Surg (Br), 2003, 85(1): 68-73.
2.	Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg (Am), 2002, 84-A(9): 1541-1551.
3.	Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, (138): 94-104.
4.	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.
5.	Hanratty BM, Thompson NW, Wilson RK, et al. The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant. J Bone Joint Surg (Br), 2007, 89(7): 915-918.
6.	Simpson D, Keating JF. Outcome of tibial plateau fractures managed with calcium phosphate cement. Injury, 2004, 35(9): 913-918.
7.	Honkonen SE. Indications for surgical treatment of tibial condyle fractures. Clin Orthop Relat Res, 1994, (302): 199-205.
8.	Cooke TD, Li J, Scudamore RA. Radiographic assessment of bony contributions to knee deformity. Orthop Clin North Am, 1994, 25(3): 387-393.
9.	Paley D, Herzenberg JE, Tetsworth K, et al. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am, 1994, 25(3): 425-465.
10.	Stevens DG, Beharry R, McKee MD, et al. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma, 2001, 15(5): 312-320.
11.	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.
12.	Mithöfer K, Gill TJ, Vrahas MS. Tibial plateau fracture following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2004, 12(4): 325-328.
13.	王宝军, 高化, 李亚东, 等. 胫骨平台骨折手术治疗的中远期疗效分析. 中华骨科杂志, 2009, 29(8):754-759.
14.	Martin J, Marsh JL, Nepola JV, et al. Radiographic fracture assessments: which ones can we reliably make? J Orthop Trauma, 2000, 14(6): 379-385.

1. Keating JF, Hajducka CL, Harper J. Minimal internal fixation and calcium-phosphate cement in the treatment of fractures of the tibial plateau. A pilot study. J Bone Joint Surg (Br), 2003, 85(1): 68-73.
2. Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg (Am), 2002, 84-A(9): 1541-1551.
3. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, (138): 94-104.
4. 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.
5. Hanratty BM, Thompson NW, Wilson RK, et al. The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant. J Bone Joint Surg (Br), 2007, 89(7): 915-918.
6. Simpson D, Keating JF. Outcome of tibial plateau fractures managed with calcium phosphate cement. Injury, 2004, 35(9): 913-918.
7. Honkonen SE. Indications for surgical treatment of tibial condyle fractures. Clin Orthop Relat Res, 1994, (302): 199-205.
8. Cooke TD, Li J, Scudamore RA. Radiographic assessment of bony contributions to knee deformity. Orthop Clin North Am, 1994, 25(3): 387-393.
9. Paley D, Herzenberg JE, Tetsworth K, et al. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am, 1994, 25(3): 425-465.
10. Stevens DG, Beharry R, McKee MD, et al. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma, 2001, 15(5): 312-320.
11. 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.
12. Mithöfer K, Gill TJ, Vrahas MS. Tibial plateau fracture following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2004, 12(4): 325-328.
13. 王宝军, 高化, 李亚东, 等. 胫骨平台骨折手术治疗的中远期疗效分析. 中华骨科杂志, 2009, 29(8):754-759.
14. Martin J, Marsh JL, Nepola JV, et al. Radiographic fracture assessments: which ones can we reliably make? J Orthop Trauma, 2000, 14(6): 379-385.

Chinese Journal of Reparative and Reconstructive Surgery

AN IMPROVED REDUCTION TECHNIQUE FOR DEPRESSION FRACTURES OF LATERAL TIBIAL PLATEAU

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