Anterolateral plus posteromedial approaches for treatment of complex tibial plateau fractures / 中华创伤骨科杂志

ABSTRACT

Objective To investigate surgical outcomes of anterolateral plus posteromedial approaches for treatment of complex tibial plateau fractures.Methods We reviewed 68 patients with tibial plateau fractures of Schatzker types Ⅴ and Ⅵ who had been treated from January 2008 to December 2011 and fully followed up in our department.They were 42 men and 26 women,22 to 64 years of age (average,42.3 years).Fractures occurred at the left side in 24 cases and at the right side in 44 cases.Intervals between injury and operation ranged from 3 to 15 days,7.4 days on average.All of them were operated on through anterolateral plus posteromedial approaches.T-or L-shaped steel plates were used laterally while reconstruction plates or T-shaped plates for distal radius were used medially.Results In this cohort the operation time averaged 3.13 hours,intraoperative blood loss 562.7 mL and hospital stay 20.4 days.All cases were followed up for an average of 18.8 months (range,12 to 38 months).Fractures healed from 4 to 8 months,6.7 months on average.The average tibial plateau angle,posterior slope angle and femorotibial angle immediately postoperation were respectively 87.3°± 1.5°,12.0°± 2.5° and 170.0°± 2.5°,not significantly different from those at one year postoperation (86.8° ± 1.2°,13.0° ± 1.8° and 171.0° ± 1.7°) (P ＞ 0.05).According to The Hospital for Special Surgery Score,the outcomes were excellent in 36 cases,good in 24 cases,fair in 6 cases and poor in 2 cases,with a good to excellent rate of 88.2％.No neural or vascular injury,deep infection,or implant failure was found in this group.Conclusion Anterolateral plus posteromedial approaches are effective for complex tibial plateau fractures,leading to anatomic reduction,stable fixation and early functional rehabilitation.