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BACKGROUND: Simple posterolateral tibial plateau collapse fracture is very rare in the clinic. The displaced collapse fracture in this area must be anatomically reduced, filled with suitable materials, and fixed with internal fixators. OBJECTIVE: To evaluate the stability, clinical results and biocompatibility of modified posterolateral approach to treat simple posterolateral tibial plateau collapse fracture with beta-tricalcium phosphate combined with T-shaped locking plate. METHODS: Fifteen patients with simple posterolateral tibial plateau collapse fractures who received surgical treatment between June 2013 and December 2017 in Zhangjiagang Hospital Affiliated to Soochow University. These patients included 8 males and 7 females, aged 25-53 years. All of them received surgical treatment with beta-tricalcium phosphate combined with T-shaped locking plate through the modified posterolateral approach. After surgery, they were followed up for 12 months. X-ray examination was performed to evaluate fracture healing and internal fixation. Reduction effect was evaluated by Rasmussen radiology score. Knee function and stability were evaluated by HSS knee function score, Lachman test, pivot-shift test and lateral stress test. This study was approved by Medical Ethics Committee, Zhangjiagang Hospital Affiliated to Soochow University, China (approval No. 201305KS001). RESULTS AND CONCLUSION: (1) All patients underwent anatomical reduction of knee fractures, and the fracture healing time was 9-14 weeks. At 12 months after surgery, p-tricalcium phosphate was completely absorbed and replaced by new bone, and repair of bone defect was satisfactory. (2) There were no significant differences in posterior tibia angle, varus angle, Rasmussen imaging collapse score and Rasmussen imaging total score between 12 months after surgery and immediately after surgery in 15 patients (P > 0. 05). (3) At 12 months after surgery, the HSS score of the knee joint was 89-100, and Lachman test, pivot-shift test and lateral stress test results were negative in 15 patients. (4) During the follow up period, infection around implants, allergic reaction, immune reaction, or rejection reaction was not observed. (5) These findings suggest that treatment of simple posterolateral tibial plateau collapse fracture through the modified posterolateral approach with p-tricalcium phosphate combined with T-shaped locking plate exhibits good repair effects and biocompatibility.
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BACKGROUND: Posterolateral tibial plateau fracture is a special type of tibial plateau fracture. Because of its special anatomical location, there are many kinds of surgical approaches and implants used in the treatment in and outside China, but no consensus has been reached. OBJECTIVE: To summarize various surgical approaches and implants by analyzing the local anatomical structure and fracture types of the posterolateral tibial plateau. METHODS: The databases of Wanfang Medical Network, China National Knowledge Infrastructure and PubMed were searched by computer. Using the keywords of “tibial plateau fracture; posterolateral tibial plateau fracture; internal fixation; surgical approach” in Chinese and English. According to the inclusion and exclusion criteria, 54 related articles were finally included and summarized. RESULTS AND CONCLUSION: There are local structures of common peroneal nerve, anterior tibial artery and fibular head on the posterolateral tibial plateau, which will affect the operation. The commonly used fracture types are Schatzker, AO/ATO, three-column classification systems and posterior column 4 zone. Posterior column 4 zone has a more definite guiding effect on posterolateral tibial plateau fractures. There are many kinds of surgical approaches and internal plants for the treatment of posterolateral tibial plateau fractures, and the optimal selection should be made according to the fracture characteristics. For simple posterolateral tibial plateau fractures, the posterolateral approach has a certain advantage over other approaches. Posterolateral supporting plate has a better supporting effect on posterolateral shear fracture of tibial plateau.
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Introducción Las fracturas del platillo tibial posterolateral exigen un abordaje que permita una buena visualización de la superficie articular para su restitución anatómica, restablecimiento de la altura y un espacio adecuado para la aplicación del material de osteosíntesis y fijación estable. Hay diversos abordajes descritos en la literatura que no proporcionan la visualización deseada o conllevan múltiples limitaciones y/o complicaciones. El propósito de este estudio es describir una modificación a la técnica quirúrgica de la osteotomía de la fíbula para el manejo de las fracturas de platillo tibial posterolateral. Materiales y métodos Se presentan los resultados clínicos de una serie de casos retrospectiva de 15 pacientes con fracturas de platillo tibial posterolateral que al momento del estudio tenían un seguimiento promedio de 6 meses. Resultados Los resultados funcionales en escala de Lysholm fueron excelentes en 3 pacientes, buenos en 8 y regulares en 4. En todos los pacientes se logró una reducción satisfactoria de la superficie articular de la tibia, sin pérdida de altura de la misma, con alineación adecuada, sin síntomas de inestabilidad, todos con consolidación de la fíbula que no retrasó la rehabilitación, no hubo lesiones del nervio peroneal ni problemas con la piel; se presentó un caso de infección superficial que se manejó con antibióticos orales sin complicaciones. Discusión El abordaje descrito facilita una amplia exposición de la superficie articular, es técnicamente fácil y reproducible, permite la reducción y fijación necesaria, con menor riesgo de complicaciones, con la cual se conserva el aporte vascular de la tibia proximal, se evita el daño a la articulación tibiofibular proximal y se propicia una mayor área de consolidación de la osteotomía. Ésta técnica puede utilizarse sola o en combinación con otros abordajes, para fracturas agudas o crónicas con mala unión. Consideramos que el abordaje con la técnica descrita es una alternativa para el manejo de las fracturas posterolaterales, con resultados alentadores.
Background Fractures of the posterolateral tibial plateau require an approach that allows a good visualization of the articular surface for its anatomical restitution, restoration of height and an adequate space for the application of osteosynthesis material and stable fixation. There are several approaches described in the literature that do not provide the desired visualization or involve multiple limitations and / or complications. The purpose of this study is to describe a modification to the surgical technique of the fibula osteotomy for the management of posterolateral tibial plate fractures. Methods We present the clinical results of a retrospective case series of 15 patients with posterolateral tibial plate fractures that at the time of the study had an average follow-up of 6 months. Results Functional results in Lysholm scale were excellent in 3 patients, good in 8 and regular in 4. Good results were obtained in all patients with a reduction of the tibia articular surface, without loss of height of the same, with alignment adequate, without symptoms of instability, all with consolidation of the fibula that did not delay rehabilitation, there were no peroneal nerve injuries or problems with the skin; There was a case of superficial infection that was managed with oral antibiotics without complications. Discussion The described approach facilitates a broad exposure of the articular surface, is technically easy and reproducible, allows the necessary reduction and fixation, with a lower risk of complications, with which the vascular supply of the proximal tibia is conserved, the damage is avoided to the proximal tibiofibular joint and a greater area of consolidation of the osteotomy is favored. This technique can be used alone or in combination with other approaches, for acute or chronic fractures with poor union. We consider that the approach with the described technique is an alternative for the management of posterolateral fractures, with encouraging results.
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Humans , Knee , Surgical Procedures, Operative , Fractures, BoneABSTRACT
Objective To explore the clinical efficacy of lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating for simple posterolateral tibial plateau fractures.Methods From January 2014 to February 2017,11 patients with simple posterolateral tibial plateau fracture were treated at Department of Orthopaedics,General Hospital of Middle Military Command of PLA.They were 8 males and 3 females,aged from 21 to 55 years (average 41.8 years).In all of them the supra-fibular-head approach was used for lateral osteotomy according to the size and orientation of the fracture block.After the fracture was reset,a full bone graft was implanted under direct visualization,followed by fixation of the posterolateral bone mass with a lateral locking plate which was placed as far as possible above the fibular head.The patients were encouraged 6 weeks after surgery to do knee functional exercise within 90°.The therapeutic efficacy was evaluated at the final follow-up according to the Rasmussen's criteria for knee functions.Results The average operative time was 74 minutes (from 55 to 90 minutes);the average intraoperative blood loss was 70 mL (from 40 to 120 mL).All the patients were followed up for 12 to 35 months (average,17.5 months).No neurovascular injury or incision infection was observed.Bony union was achieved in all patients after 10 to 15 weeks (average,12.5 weeks).Follow-ups found no implant loosening/breakage,genu valgum,genu varum,fracture redisplacement,or knee instability.According to the Rasmussen's function evaluation of the knee joint,10 cases were rated as excellent and one as good.Conclusion Lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating is a preferred treatment for simple posterolateral tibial plateau fractures.
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Objective To study the efficacy of fixation with knee arthroscopy as adjuvant therapy for lateral tibial plateau fracture. Methods 72 cases with lateral tibial plateau fracture of our hospital from September 2011 to September 2014 were divided into experimental group (36 cases) and control group (36 cases), according to different operation method, the experimental group using arthroscopic, while the control group using traditional incision surgery. Then the incision length, operative time, hospital stay, wound healing, bone healing time were compared. Complications, knee function and reduction of the fracture were compared. Results The incision length of experimental group was significantly lower than the control group, the difference was statistically significant (P <0.05). Operative time, hospital stay, wound healing time, the bone healing time were significantly lower than the control group, the differences were statistically significant (P < 0.05). Delay healing, joint stiffness and traumatic arthritis were significantly lower than the control group, the differences were statistically significant (P < 0.05). RASMUSSEN function score and radiographic scores in the experimental group were significantly higher than the control group, the differences were statistically significant (P < 0.05). Conclusion Fixation with knee arthroscopy as adjuvant therapy for lateral tibial plateau fracture has advantages of smaller incision, shorter operative time and hospital stay and healing time, lower complication rate while better reduction of the fracture and function than conventional methods.