Treatment of complex hyperextension tibial plateau fractures via combined anteromedial and anterolateral approaches / 中华创伤骨科杂志

ABSTRACT

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.