Proximal tibial lateral locking plate with rafting screws combined with Jail screws in the treatment of collapse fracture of the lateral tibial plateau / 中华创伤杂志

ABSTRACT

Objective:To explore the efficacy of the proximal tibial lateral locking plate with rafting screws combined with Jail screws in the treatment of collapse fracture of the lateral tibial plateau.Methods:A retrospective case series study was performed on clinical data of 36 patients with collapse fracture of the lateral tibial plateau admitted to Suqian Hospital of Nanjing Drum Tower Hospital Group from January 2016 to January 2020, including 19 males and 17 females, aged 34-68 years [(48.6±5.8)years]. Schatzker classification was type II in 28 patients and type III in 8 patients. All patients were treated using the proximal tibial lateral locking plate with raft screws combined with Jail screws. The operation time, intraoperative blood loss and fracture healing were detected. The distance of articular surface collapse of the tibial plateau, posterior inclination angle (PSA) of the tibial plateau, tibial plateau varus angle (TPVA) and Rasmussen anatomical score were compared before operation and at day 2 and 1 year after operation. The Hospital for Special Surgery (HSS) score was used to evaluate knee function at day 2 and 1 year after operation. Complications were also recorded.Results:All patients were followed up for 12-32 months [(19.5±3.1)months]. The operation time was 56-82 minutes [(68.5±9.1)minutes]. The intraoperative blood loss was 40-100 ml [(75.6±10.2)ml]. The fracture was clinically healed by first-stage, with the healing time of 8 to 15 weeks [(12.5±1.3)weeks]. The distance of articular surface collapse of the tibial plateau was improved from (15.5±4.2)mm before operation to (0.7±0.3)mm at day 2 after operation and (1.0±0.2)mm at 1 year after operation (all P<0.01). The PSA was improved from (21.2±2.1)° before operation to (8.9±0.8)° at day 2 after operation and (9.2±0.6)° at 1 year after operation (all P<0.01). The TPA was improved from (100.2±3.7)° before operation to (88.9±1.8)° at day 2 after operation and (87.2±1.6)° at 1 year after operation (all P<0.05). The Rasmussen anatomical score changed from (7.8±1.8)points before operation to (17.1±0.9)points at day 2 after operation and (16.3±0.7)points at 1 year after operation (all P<0.01). There were no significant difference in the distance of articular surface collapse of the tibial plateau, PSA, TPVA and Rasmussen anatomical score at day 2 and 1 year after operation (all P>0.05). The HSS score was (92.8±3.2)points at 1 year after operation, significantly higher than (74.8±3.5) points at day 2 after operation ( P<0.01). Two patients sustained superficial wound infection after operation, which healed after debridement and dressing change. No deep infection occurred. Conclusion:For patients with collapse fracture of the lateral tibial plateau, the proximal tibial lateral locking plate with rafting screws combined with Jail screws can effectively prevent secondary collapse of the articular surface and obtain satisfactory anatomical reduction, good functional recovery and few postoperative complications.