A posterior reversed L-shaped approach for the tibial plateau fractures-A prospective study of complications (95 cases).

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.

[N2O emissions and ammonia volatilization from leachate irrigated soils].

The effect of soil properties on N2O emissions and ammonia volatilization after leachate addition was investigated by soil S1 and S2 through incubation experiment. The conversions of soil NH4(+)-N and NO3(-)-N contents after leachate addition were evaluated as well. Soil pH dominantly determines the ammonia volatilization after leachate addition and ammonia volatilization only happens by soil S1 of alkaline nature within the first 5-day during the 10-day incubation. Approximately 3.0% leachate ammonia-N is lost via ammonia volatilization from soil S1. After being added the same amount of leachate ammonia-N, there is an approximately 20-fold gap of N2O emissions between two different soils: soil S1 and S2 (p <0.01). Soil moisture content affects the net generation rate of NO3(-)-N contents substantially and N2O fluxes are thus regulated accordingly. Compared with soils moisture content at water-filled pore space (WFPS) of 46%, N2O fluxes are elevated by 6.5, 1.8, and 2.2 times from the leachate added soil S1 without leachate irrigation (p > 0.05), the leachate added soil S1 (p > 0.05), and the leachate added soil S2 (p <0.05), respectively. During the 10-day incubation, N2O emissions cause 41.1% and 2.3% leachate NH4(+)-N loss from the leachate added soil S1 and S2, respectively. Therefore, avoiding excessively wet conditions (< 70% WFPS) and selecting acidic soil could minimize the potential N2O emissions and ammonia volatilization under leachate irrigation.