ABSTRACT
PURPOSE: This study was aiming to investigate intraoperative and postoperative complications and outcomes of a posterior reversed L-shaped approach (PRLA) in the treatment of the tibial plateau fractures. METHODS: Inclusion criterion was tibial plateau fractures treated through the PRLA either separated or combined with other approaches. Main exclusion criterion was poly-trauma patients. Ninety-five patients with tibial plateau fractures from a prospectively collected database were included and followed in this study. The intraoperative and postoperative complications consisted of vascular and nerve injury, wound infection, dehiscence, haematoma, nonunion, skin necrosis and skin paresthesia. Hospital for Special Surgery Knee Score (HSS) was adopted to evaluate patients' knee function while Short Form 36 Health Survey (SF-36) was used to investigate the patients' general health status. RESULTS: Patients' average age was 46.2 years old (range, 22.0-89.0). The fractures were mainly from high energy injuries involving posterior (and medial) column. 78 of 95 cases were combined with an additional anterolateral approach due to the lateral column involvement. The average follow-up was 52.0 months (range, 12.4-102.6). The total complications rate was 4.2% (4/95). Intraoperative complications occurred in two patients (2.1%). One suffered a popliteal artery injury resulted from an antero-posteriorly drilled K-wire. The patient had a loss of 7° knee extension at one year's follow-up. The other endured an injury of nutrient vessel within the medial head of gastrocnemius. Postoperative skin paresthesia occurred in two patients (2.1%). The other complications associated with the PRLA were not observed. The mean HSS score was 96.1 (range, 80-100). The mean SF-36 score was 94.2 (range, 80-100). CONCLUSIONS: The posterior reversed L-shaped approach allows satisfied visualization of the medial and posterior tibial plateau and has promising clinical results with low complication occurrence. It can be recommended as a routine approach for the treatment of the tibial plateau fractures involving the posterior column.
Subject(s)
Fracture Fixation, Internal/methods , Knee Joint/physiopathology , Peripheral Nerve Injuries/surgery , Postoperative Complications/surgery , Tibial Fractures/surgery , Adult , Bone Plates , Female , Fracture Fixation, Internal/adverse effects , Fracture Healing , Humans , Male , Middle Aged , Peripheral Nerve Injuries/epidemiology , Peripheral Nerve Injuries/prevention & control , Postoperative Complications/physiopathology , Practice Guidelines as Topic , Prospective Studies , Range of Motion, Articular , Recovery of Function , Tibial Fractures/complications , Tibial Fractures/physiopathology , Treatment OutcomeABSTRACT
INTRODUCTION: This study aimed to investigate the surgical techniques and the clinical efficacy of combined approaches for the treatment of Schatzker type II tibial plateau fractures involving the posterolateral column [lateral and posterolateral columns (LPCs) fractures] in a prospective cohort. MATERIALS AND METHODS: From January 2007 through December 2010, a total of 65 patients with LPCs underwent dual-plate fixation via a combined anterior and posterior approach. The anterior and posterior approaches were the conventional anterolateral approach and a posteromedial inverted L-shaped approach, respectively, with the patients in a floating position. RESULTS: Ultimately, 41 patients were followed up for a mean period of 52.5 months. All fractures healed. The mean time to radiographic bony union was 15.2 weeks and the mean time to full weight-bearing was 18.7 weeks. No parameter associated with knee alignment changed significantly between immediately postoperation and 2 years postoperation. No collapse of the reduced articular surface was detected. Two years postoperation, the mean Hospital for Special Surgery score was 92.3; the mean Short Form-36 score was 90.1, and the mean range of knee motion was 1.7°-123.6° (extension-flexion). Two patients suffered dehiscence of the anterolateral incision and another suffered partial necrosis at the margin of the posteromedial incision postoperatively. All healed in response conservative treatment. Another two patients experienced numbness in the posteromedial inferior region of the calf. No implant loosening, breakage, fixation failure, or other complication was observed during follow-up. CONCLUSIONS: LPCs are not uncommon. Careful preoperative analysis of computed tomography images and impeccable preparation are necessary to avoid neglecting a posterolateral column fracture. It is inappropriate to generalize one scenario for all Schatzker type II fractures: a single approach cannot address all subtypes of these fractures. Dual-plate fixation via a combined approach is an effective treatment for LPCs.
