Plate fixation via extended Carlson approach for tibial plateau fracture with combined posterolateral and anterolateral fragments / 中华创伤杂志

ABSTRACT

Objective:To investigate the clinical outcome of extended Carlson approach to plate fixation of tibial plateau fracture with combined posterolateral and anterolateral fragments.Methods:A retrospective case series study was made on 16 patients with tibial plateau fracture with combined posterolateral and anterolateral fragments admitted to First Affiliated Hospital of Fujian Medical University from January 2015 to September 2019. There were 10 males and 6 females, with age of (35.2±4.3)years (range, 22-59 years). According to the Schatzker fracture classification, type II was found in 10 patients, type III in 4, type V in 1 and type VI in 1. Two-column fractures were found in 14 patients and three-column fracture in 2 patients. All patients were treated by plate fixation through the extended Carlson approach. The anterior-posterior X-ray and 3D reconstruction CT scan test were taken at every 3 months after operation to assess fracture healing and posterior tilt angle of lateral tibial plateau. The Rasmussen knee function score was performed 12 months after operation. Complications were detected as well.Results:All patients were followed up for 13-38 months [(18.3±4.6)months]. All patients showed bone healing. At postoperative 12 months, the posterior tilt angle of lateral tibial plateau was reduced to (11.5±4.7)°, compared to preoperative (28.9±3.2)° ( P<0.05). At postoperative 12 months, the Rasmussen score was (25.8±1.1)points compared with preoperative (13.1±3.8)points ( P<0.05), and the results were excellent in 9 patients (56%), good in 6 (37%), and fair in 1 (6%), with the excellent-good rate of 94%. No complications were observed, such as skin necrosis, surgical site infection, internal fixator exposure or osteomyelitis. Conclusion:For tibial plateau fracture with combined posterolateral and anterolateral fragments, plate fixation via the extended Carlson approach is effective to reduce and fix the fracture, decrease the posterior tilt angle of lateral tibial plateau and improve the recovery of postoperative knee function, with no neurovascular injury complications.