ABSTRACT
Objective:To evaluate the biomechanical performance of our self-designed anatomical plate for posterolateral tibial plateau in comparison with conventional plates for treatment of posterolateral tibial plateau fractures.Methods:A novel anatomic plate for posterolateral tibial plateau was designed according to the data measured in the superior fibular capitulum and 3D CT segmentation. Twenty-four knee joints were obtained from 12 freshly frozen adult cadavers to make models of posterolateral tibial plateau fracture. The models were divided into 3 groups( n=8). In group A, fixation was simulated via the supra-fibular-head approach after autogenous iliac bone-graft by our self-designed anatomic plate for posterolateral tibial plateau; in group B, fixation was simulated via the posterior tibial approach after autogenous iliac bone-graft by a small T-plate; in group C, fixation was simulated via the supra-fibular-head approach after autogenous iliac bone-graft by a normal L-plate. Biomechanical tests were carried out in the 3 groups to measure the vertical displacements of split bone fragment under the vertical compression loads of 500 N, 1,000 N and 1,500 N and the maximum compression upon failure of internal fixation (compressed displacemen t=3 mm). Results:At the vertical compression loads of 500 N, 1,000 N and 1,500 N, the vertical displacements of split bone fragment showed significant differences among the 3 groups ( P<0.05); there was a significant difference between group C and groups A and B, respectively ( P<0.05), but an insignificant difference between group A and group B ( P>0.05) though group A performed slightly better. In terms of the maximum compression upon failure of internal fixation, significant differences existed among the 3 groups ( P<0.05); there was a significant difference between group C and groups A and B, respectively ( P< 0.05), but an insignificant difference between group A and group B ( P>0.05). Conclusions:Our self-designed anatomic plate for posterolateral tibial plateau can firmly fixate the fracture fragments of posterolateral condyle.
ABSTRACT
Objective To design an approach above the fibular head for treating posterolateral tibial plateau fracture,and to investigate its feasibility,advantages and disadvantages in clinical application.Methods Ten frozen adult cadaveric knees were dissected to observe the correlation of the important lateral structures and effect of knee flexion on tensity of the lateral collateral ligament.The distance (OA) from superior border of facies articularis capitis fibulae to lateral edge of articular surface of tibial plateau and the distance (OB) from the cross point of lateral collateral ligament and facies articularis capitis fibulae level to lateral edge of articular surface of tibial plateau were measured.According to the anatomic measurement results,the approach above the fibular head was designed.Then 12 patients with posterolateral tibial plateau fracture were treated through this approach,and the short-term clinical results were evaluated.Results The value of OA ranged from 9.43 to 14.92 mm (average,12.97±1.83 mm).At 0° of genuflex,the lateral collateral ligament was tense and the average value of OB was 4.87±0.33 mm.During the course of genuflex,the lateral collateral ligament got loose following which the value of OB became larger.At 60° of genuflex,the lateral collateral ligament was most loose,and the posterolateral tibial plateau could be exposed completely by drawing posterolaterally lateral collateral ligament and rotating medially tibia.All patients were followed up for 6 to 24 months (average,18 months).The average bone healing time was 10.2 weeks (8 to 12 weeks).According to Rasmussen's knee functional score system,the results were excellent in 10 cases and good in 2 cases.No complications occurred,such as numbness of limbs,instability of the knee and internal fixation loosening.Conclusion The approach above the fibular head is feasible,simple and safe for treating posterolateral tibial plateau fracture.
ABSTRACT
Objective To discuss anatomical characteristics and clinical results of the lateral superior genicular artery perforator iliotibial band flap. Methods From September 1999 to July 2009, the origin,course, branches and distribution of the lateral superior genicular artery and blood supply of iliotibial band were observed on 40 sides adult lower limbs perfused with red latax. Five perforator iliotibial band and 4 perforator iliotibial band flaps of 9 cases were treated with anastomosis of lateral superior genicular artery perforating rami. Results The lateral superior genicular artery of 35 cases (80%) originates from the popliteal artery. Its originated external diameter was (1.8 ± 0.4) mm. It divides into ascending branch and descending branch, and they gives off septofascio-cutaneous perforator, or anatomoses the lateral uppermost genicular artery in the vastus lateralis muscle, and then formes the musculocutaneous perforator of iliotibial band. The originated external diameter of the larger perforator of iliotibial bands was ( 1.0 ± 0.2) mm and they provides for the skin and iliotibial band of lateral superior genicular area. Nine cases, including 5 cases of simple Achilles tendon defects, two cases of achilles tendon defects with skin defects, and 2 cases of lower extremity and foot soft tissue defects were treated with transplantation of the vascularized iliotibial band (flap) with perforator vascular anastomoses. All cases were followed up 6 - 92 months. The results showed significant improvement in "heel test" and Thompson sign in the rerupture of the Achilles tendon occurred. Four perforator iliotibial band flaps survived well. Conclusion The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and new donor in the reconstruction of soft tissue and composite defects.