Combined posteromedial and anterolateral approach for reduction and internal fixation in the treatment of Wahlquist type C medial tibial plateau fracture with coronal subluxation of knee joint / 中华骨科杂志

ABSTRACT

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.