A comparative clinical investigation of tibial plateau fractures managed with double reverse traction reducers / 中华骨科杂志

ABSTRACT

Objective:To evaluate the clinical outcomes of internal fixation using double reverse traction reducers in the treatment of tibial plateau fractures.Methods:This study retrospectively examined the medical records of 48 patients who underwent surgical intervention for tibial plateau fractures at the Affiliated Hospital of Qingdao University between January 2021 and September 2022. The cohort, aged between 35 to 68 years (mean: 53.0±7.9 years), included 23 males and 25 females. Fractures were classified according to the Schatzker system, with 9 type III, 23 type IV, 11 type V, and 5 type VI fractures recorded. Patients were divided into two groups based on the surgical approach: the minimally invasive group underwent treatment with double reverse traction reducers for reduction and internal fixation in 24 cases, while the open group received conventional open reduction and internal fixation in 24 cases. Comparative parameters included operation duration, intraoperative blood loss, hospital stay, early postoperative knee mobility, and weight-bearing timelines. Postoperative radiographic images were appraised using the Rasmussen imaging score, and knee functionality was assessed at the final follow-up with the Hospital for Special Surgery (HSS) score and the International Knee Documentation Committee (IKDC) score.Results:The preoperative general data were statistically indifferent between groups ( P>0.05). All patients were followed for 13.5±4.3 months (range, 9.5-24 months). In the minimally invasive group, operative time was 88.96±19.04 minutes, intraoperative blood loss was 65±32 ml, and hospital stay was 11.8±3.9 days. Early postoperative knee joint activity commenced at 8.96±2.84 days, significantly earlier compared to the open group, which recorded 178.63±67.75 minutes of surgery, 114.16±65.05 ml blood loss, a 15.3±4.8 days hospital stay, and 16.83±4.09 days to knee joint movement. The difference was statistically significant ( P<0.05). No significant variation was observed in the time to bone healing between the minimally invasive group at 12.6±3.8 weeks and the open group at 13.21±4.98 weeks ( P>0.05). Rasmussen imaging criteria revealed 21 excellent and 3 good outcomes in the minimally invasive group, and 19 excellent and 5 good in the open group, with no statistical significance in the excellent-good rate differentiation ( P>0.05). Bone healing occurred within 3.2±0.8 months (range, 2.5-6.0 months), with 79% (19/24) in the minimally invasive group and 75% (18/24) in the open group achieving healing within 3 months. The open group had one incidence of superficial skin infection, and one patient in the minimally invasive group developed deep vein thrombosis (DVT); no other related complications were documented. Conclusion:Minimally invasive treatment of tibial plateau fractures using double reverse traction reducers offers significant benefits, including reduced surgical time, minimal blood loss, less soft tissue trauma, and enhanced joint function recovery. This approach is particularly advantageous in managing complex tibial plateau fractures compared to traditional open reduction and internal fixation methods.