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Chinese Journal of Orthopaedics ; (12): 349-356, 2022.
Article in Chinese | WPRIM | ID: wpr-932842


Objective:To compare the efficacy of posteromedial and anterolateral approach and single posteromedial reversed L approach for reduction and internal fixation in the treatment of Wahlquist type C medial tibial plateau fracture (mTPF) with coronal subluxation of knee joint.Methods:A retrospective analysis was conducted on 44 surgically treated Wahlquist type C mTPFs from January 2010 to April 2021. They were divided into single-approach group (21 cases, 12 males and 9 females with mean age of 50.71±11.28 years) and combined-approach group (23 cases, 16 males and 7 females with mean age of 51.00±10.07 years) according to their surgical approach. The single-approach group contained 14 left limbs and 7 right limbs, and there were 19 anteromedial-posteromedial-posterolateral mTPF and 2 posteromedial-posterolateral mTPF. The combined-approach group contained 18 left limbs and 5 right limbs, and there were 22 anteromedial-posteromedial-posterolateral mTPF and 1 posteromedial-posterolateral mTPF. The intraoperative blood loss and incidence of blood transferring were assessed according to the anesthetic recording. The incidence of residual knee subluxation and articular surface step, medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) were measured on the postoperative plain radiograph and the function recovery of the affected knee was evaluated by the short musculoskeletal function assessment (SMFA) and the visual analogue scale (VAS).Results:The intraoperative blood loss in combined-approach group was 597.83±89.79 ml and 516.67±79.58 ml in single-approach group, there was a significant difference between the two groups ( t=3.16, P=0.003). The incidence of blood transferring was 17% (4/23) in the combined-approach group and 14% (3/21) in the single-approach group, with no significant difference (χ 2=0.08, P=0.78). All 44 patients were followed up for 8 to 133 months (mean 54 months). The rate of the residual knee subluxation and unsatisfied articular surface reduction in the combined-approach group was lower than that in the single-approach group (34.8% vs. 76.2%, χ 2=7.59, P=0.006; 30.4% vs. 61.9%, χ 2=4.39, P=0.036). There was no significant difference between the combined-approach group and single-approach groups in the postoperative MPTA (86.67°±3.31° vs. 85.86°±4.36°, t=0.88, P=0.386) and PPTA (81.57°±3.22° vs. 83.90°±6.80°, t=1.44, P=0.162). The SMFA and VAS score sin the combined-approach group were significantly better than single-approach groups (20.52±11.04 vs. 31.19±16.79; t=2.51, P=0.016; 2.74±1.32 vs. 3.76±1.04; t=3.13, P=0.007). Conclusion:The efficacy of combined posteromedial and anterolateral approach in the treatment of Wahlquist type C mTPF with coronal subluxation of knee joint is superior to that of traditional single posteromedial reversed L approach.

Article in Chinese | WPRIM | ID: wpr-867957


Objective:To conduct an MRI observation on the incidences of ligamentous injuries and fracture morphology in Schatzker type Ⅳ tibial plateau fracture (TPF) and investigate their influence on knee stability.Methods:A retrospective analysis was conducted of the 30 patients with Schatzker type Ⅳ TPF who had undergone surgery at Department of Orthopaedic Trauma, Jiangsu Provincial People's Hospital from January 2010 to December 2019 and whose preoperative X-ray, CT and MRI were available. They were 18 males and 12 females, aged from 22 to 75 years (mean, 45.4 years). They were divided into a dislocation-free group and a dislocation group according to the absence or presence of knee dislocation on their anteroposterior X-ray films. The fracture morphology was assessed on CT according to the modified three-column classification. The incidences of ligamentous injuries [involving anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), posterolateral complex (PLC) and anterolateral ligament (ALL)] were investigated on MRI. The 2 groups were compared in fracture morphology and incidences of ligamentous injuries. Multiple linear regression (MLR) analysis was used to identify the main factor contributing to preoperative knee dislocation.Results:The dislocation group had 12 patients and the dislocation-free group 18. The fracture involving medial+posteromedial+posterolateral columns was found in 66.7% of the patients (20 cases), and accounted for 83.3% (10 cases) in the dislocation group. The incidence was 96.7% (29 cases) for ACL injury, 43.3% (13 cases) for PCL injury, 70.0% (21 cases) for MCL injury, 90% (27 cases) for PLC injury, 73.3% (22 cases) for ALL injury and 90% (27 cases) for the multiple-ligament disruption. There was a significant difference in the posterolateral column injury between the dislocation-free group [55.6% (10/18)] and the dislocation group [91.7% (11/12)] ( P < 0.05), but there were no significant differences between the 2 group in the injury to any other single ligament or multiple ligaments ( P>0.05). The MLR analysis confirmed that the posterolateral column injury was a risk factor for coronary plane dislocation in Schatzker type Ⅳ TPF( P<0.05). Conclusions:In Schatzker type Ⅳ TPF, the incidences of ligamentous injuries are very high but the fracture of posterolateral column may be the main cause for preoperative knee dislocation in some patients.

Article in Chinese | WPRIM | ID: wpr-867922


Objective:To evaluate the outcomes of complex hyperextension tibial plateau fractures treated via combined anteromedial and anterolateral approaches.Methods:From January 2013 through July 2018, 11 complex hyperextension tibial plateau fractures were surgically treated at Department of Orthopaedics, The First Affiliated Hospital to Nanjing Medical University. The patients were 7 males and 4 females, aged from 23 to 62 years (average, 41.5 years). All the fractures affected both tibial condyles. Of them, 6 had hyperextension varus injury, 3 simple hyperextension injury without varus or valgus at the coronal view, and 2 hyperextension valgus injury. All their fractures were exposed and reset via combined anteromedial and anterolateral approaches. After surgery, orthosis of the knee joint was used to protect the affected limbs and the patients were followed up regularly at the outpatients department. At the final follow-up, the knee function was evaluated using The Hospital for Special Surgery (HSS) scoring system while the posterior slope angle and the tibial plateau angle were assessed on their X-ray films.Results:No neurological symptoms were observed in the 11 patients whose wounds healed by the first intention. They were followed up from 6 to 28 months (average, 18.5 months). All the fractures obtained anatomical reduction by the X-ray after operation. Regular follow-ups showed no reduction loss, implants loosening or breakage. The fractures united after 10 to 16 weeks (average, 12.5 weeks). At immediate postoperation, the posterior slope angle was 12.8°±1.6° and the tibial plateau angle 3.8°±1.1°; at 6 months postoperation, the posterior slope angle was 11.9°±1.7° and the tibial plateau angle 3.6°±1.8°. There were no significant differences between immediate postoperation and 6 months postoperation in the above indexes ( P>0.05). At the final follow-up, the HSS scores ranged from 85 to 96 (mean, 90.4), the knee flexion from 120° to 140° (mean, 127.2°), and the knee extension from -5° to 5° (mean, 0°). Conclusions:Surgery via combined anteromedial and anterolateral approaches can lead to fine short-term outcomes for the complex hyperextension tibial plateau fracture which affects both tibial condyles. As long-term outcomes have not been available, further observations should be made. In addition, since this type of fractures is likely complicated with neurovascular or ligament lesions, attention should be paid to the injury to such soft tissues.

Chinese Journal of Orthopaedics ; (12): 705-712, 2017.
Article in Chinese | WPRIM | ID: wpr-619938


Objective To evaluate the outcomes of open reduction and internal fixation of complex tibial plateau fractures with improved three combined approaches.Methods In the period from July 2014 to February 2016,7 complex tibial plateau fractures underwent surgical treatment.These patients included 5 male and 2 female,aged from 24 to 68 years old (average,39.7± 15.3 years).According to Schatzker classification,they were all of type V.And all of type 41B-3.1 by AO/OTA classification.All these fractures were exposed and reduction via three combined approaches.First let the patients lied in lateral prone position,expose the anterolateral and the posterolateral of the tibia1 plateau,and fix the fractures of the posterior in the posterolateral approach,then fix the fractures of the lateral in the anterolateral approach.Then turn the patients to supine position,fix the fractures of the medial in the anteromedial incision.All patients received regular reexamination.The knee function was evaluated at the final follow-up using The Hospital for Special Surgery (HSS) score,the activity of the knee was evaluated by Lysholm score,and the stability of the knee was checked by Lachmantest and Pivot-shift test.The tibial plateau angle,the posterior slope angle and Rasmussen X-ray score were assessed on the X-ray films.Results The average time of operation is (3.3±0.9) h,and the hemorrhage volume in operation was (341± 106) ml for the 7 patients.The wounds of 6 patients healed by (11.8± 1.3) days,while the wound of the rest one of them occurred fat liquefaction after operation who is very fat (BMI > 30) and suffered from diabetes.His wound healed by 21 days.These patients obtained follow-ups of 8 to 14 months (average,11.4±2.8 months).The average full weight-bearing time was 2-3 months (average,2.5±0.4 months).The fractures healed after 8 to 16 weeks (average,11.1 ±2.8 weeks).No displacement of the fractures or breakage of the implants occurred in our series.Nobody has activity limitation of the knee or pain because of the implant,and no never symptoms were noted postoperatively,so we would not take out the implant for these patients.The mean HSS score was 93.1±4.8 (range,from 85 to 100) at the final follow-up,and the excellent rate is 100%.The Lysholm score was 97.1±3.6 (range,from 90 to 100) at the final follow-up.The Lachman test and the Pivot-shift test were negative in our patients,and the mean knee flexion was 128.6±12.8°(range,from 105°to 140°).The fractures were all anatomical reduction by the X-ray after operation,and there had being no displacement of the fractures or breakage of the implants occurred during the follow-up period.The mean posterior slope angle was 8.29±2.87° (range,from 4 °to 12°),which was 8.71±2.63° (range,from 5 °to 14°) 6months after operation.The mean tibial plateau angle was 86.00± 1.41° (range,from 84 °to 88°),which was 86.43± 1.62° (range,from 84 °to 89°) 6 months after operation.The mean Rasmussen X-ray score was 16.86±1.57 (range,from 14 to 18),which was 16.57±1.51 (range,from 14 to 18) 6 months after operation,and the excellent rate are 100%.Conclusion For the complex tibial plateau fractures which simultaneous involved the medial,the lateral and the posterior,the improved three combined approaches showed the advantages of the convenient operation,the satisfactory results of reduction and fixation,and the less trauma and secondary damage,and could be worth for clinic.

Article in Chinese | WPRIM | ID: wpr-418891


The incidence of deep venous thrombosis (DVT) of lower limbs is higher in the patients suffered from cancers than that in the general population.DVT complicated with cancers caused by many reasons,such as hypercoagulability,endothelial injury,stasis of blood and so on.And due to its serious consequences to the victims,the prevention and early diagnosis of DVT is very important.However,today there is still no definite standard for preventative anticoagulation in the patients of cancer.