TREATMENT OF POSTEROLATERAL TIBIAL PLATEAU COLLAPSED AND SPLITED FR ACTURES BY POSTEROMEDIAL AND ANTEROL ATER AL APPROACHES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGPeng ¹ , LIChengliang ² , CHENFangjian ¹ , YANWenshan ¹ ,  WANGWenliang ¹

1. Department of Orthopaedic Center No. 3 Joint Section, Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, 300162, P. R. China;
2. Outpatient Department of Chinese People's Armed Police Force Corps of Tianjin;

Corresponding?author：

WANGWenliang, Email: 289765450@qq.com

Keywords：

Tibial plateau fracture; Posteromedial approach; Anterolateral approach; Internal fixation; Reduction

DOI：

10.7507/1002-1892.20150232

Video：

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Objective To explore the effectiveness of posteromedial and anterolateral approaches in the treatment of posterolateral tibial plateau collapsed and splited fractures. Methods Nineteen consecutive patients with posterolateral tibial plateau collapsed and splited fractures were treated between August 2010 and August 2013, and the clinical data were retrospectively analyzed. There were 13 males and 6 females, with an average age of 36.9 years (range, 25-75 years). All cases had closed fractures, involving 8 left sides and 11 right sides. Fractures involved posterior column according to the threecolumn classification based on CT scans; according to the Schatzker classification, all fractures were type Ⅱ; according to the AO/Association for the Study of Internal Fixation classification (AO/OTA), all fractures were type 41-B3.1.2. The interval between injury and operation was 7-14 days (mean, 9 days). The reduction of collapsed fractures and implantation of artificial bone allograft were supported by T-shaped distal radius plate via the posteromedial approach. The splited fractures was fixed by less invasive stabilization system (LISS) plate via the anterolateral approach. Results The mean operation time was 69.0 minutes (range, 50-105 minutes). All incisions healed by first intention without neurovascular complications or wound infection. All patients were followed up 14-20 months (mean, 18.2 months). X-ray and CT examinations showed that collapsed tibial plateau and joint surface were completely corrected; bony union was obtained at 12 weeks on average (range, 10-16 weeks). No secondary collapsed fracture and knee varus or valgus occurred. The results were excellent in 12 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 89.5% according to the Rasmussen's scoring system for knee function. Conclusion The posteromedial approach combined with anterolateral approach for posterolateral tibial plateau fractures can fully expose the posterolateral aspects of the tibial plateau, and thus collapsed and splited fractures can be treated at the same time, which will lead to less operative time and good outcomes in the treatment of posterolateral tibial plateau collapsed and splited fractures.

Citation： ZHANGPeng, LIChengliang, CHENFangjian, YANWenshan, WANGWenliang. TREATMENT OF POSTEROLATERAL TIBIAL PLATEAU COLLAPSED AND SPLITED FR ACTURES BY POSTEROMEDIAL AND ANTEROL ATER AL APPROACHES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1072-1075. doi: 10.7507/1002-1892.20150232 Copy

1.	Partenheimer A, G?sling T, Müller M, et al. Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation. Unfallchirurg, 2007, 110(8):675-683.
2.	羅從風, 胡承方, 高洪, 等. 基于CT的脛骨平臺骨折的三柱分型. 中華創傷骨科雜志, 2009, 11(3):201-205.
3.	Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, (138): 94-104.
4.	Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium-2007:Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma, 2007, 21(10 Suppl):S1-133.
5.	Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg (Am), 1973, 55(7):1331-1350.
6.	黃文華, 姜楠, 鐘世鎮, 等. 脛骨平臺后傾角的測量及臨床意義. 中國骨與關節損傷雜志, 2007, 22(10):825-828.
7.	Stallenberg B, Gevenois PA, Sintzoff SA Jr, et al. Fracture of the posterior aspect of the lateral tibial plateau:radiographic sign of anterior cruciate ligament tear. Radiology, 1993, 187(3):821-825.
8.	Solomon LB, Stevenson AW, Lee YC, et al. Posterolateral and anterolateral approaches to unicondylar posterolateral tibial plateau fractures:a comparative study. Injury, 2013, 44(11):1561-1568.
9.	Tao J, Hang DH, Wang QG, et al. The posterolateral shearing tibial plateau fracture:treatment and results via a modified posterolateral approach. Knee, 2008, 15(6):473-479.
10.	Chen HW, Liu GD, Ou S, et al. Open reduction and internal fixation of posterolateral tibial plateau fractures through fibula osteotomyfree posterolateral approach. J Orthop Trauma, 2014, 28(9):513-517.
11.	Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma, 2005, 19(2):73-78.
12.	Lobenhoffer P, Gerich T, Bertram T, et al. Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg, 1997, 100(12):957-967.
13.	Zeng ZM, Luo CF, Putnis S, et al. Biomechanical analysisof posteromedial tibial plateau split fracture fixation. Knee, 2011, 18(1): 51-54.
14.	儲旭東, 劉曉暉, 陳偉南, 等. 經腓骨小頭上入路治療脛骨平臺后外側髁骨折的臨床研究. 中國修復重建外科雜志, 2013, 27(2): 155-159.
15.	夏江, 俞光榮, 周家鈐, 等. 經后外側入路治療脛骨平臺后外側骨折的解剖學研究及應用. 中國臨床解剖學雜志, 2010, 28(4):369-374.
16.	羅從風, 陳健, 孫輝. 脛骨平臺后柱骨折的手術治療. 中華創傷骨科雜志, 2008, 10(9):804-807.

1. Partenheimer A, G?sling T, Müller M, et al. Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation. Unfallchirurg, 2007, 110(8):675-683.
2. 羅從風, 胡承方, 高洪, 等. 基于CT的脛骨平臺骨折的三柱分型. 中華創傷骨科雜志, 2009, 11(3):201-205.
3. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, (138): 94-104.
4. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium-2007:Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma, 2007, 21(10 Suppl):S1-133.
5. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg (Am), 1973, 55(7):1331-1350.
6. 黃文華, 姜楠, 鐘世鎮, 等. 脛骨平臺后傾角的測量及臨床意義. 中國骨與關節損傷雜志, 2007, 22(10):825-828.
7. Stallenberg B, Gevenois PA, Sintzoff SA Jr, et al. Fracture of the posterior aspect of the lateral tibial plateau:radiographic sign of anterior cruciate ligament tear. Radiology, 1993, 187(3):821-825.
8. Solomon LB, Stevenson AW, Lee YC, et al. Posterolateral and anterolateral approaches to unicondylar posterolateral tibial plateau fractures:a comparative study. Injury, 2013, 44(11):1561-1568.
9. Tao J, Hang DH, Wang QG, et al. The posterolateral shearing tibial plateau fracture:treatment and results via a modified posterolateral approach. Knee, 2008, 15(6):473-479.
10. Chen HW, Liu GD, Ou S, et al. Open reduction and internal fixation of posterolateral tibial plateau fractures through fibula osteotomyfree posterolateral approach. J Orthop Trauma, 2014, 28(9):513-517.
11. Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma, 2005, 19(2):73-78.
12. Lobenhoffer P, Gerich T, Bertram T, et al. Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg, 1997, 100(12):957-967.
13. Zeng ZM, Luo CF, Putnis S, et al. Biomechanical analysisof posteromedial tibial plateau split fracture fixation. Knee, 2011, 18(1): 51-54.
14. 儲旭東, 劉曉暉, 陳偉南, 等. 經腓骨小頭上入路治療脛骨平臺后外側髁骨折的臨床研究. 中國修復重建外科雜志, 2013, 27(2): 155-159.
15. 夏江, 俞光榮, 周家鈐, 等. 經后外側入路治療脛骨平臺后外側骨折的解剖學研究及應用. 中國臨床解剖學雜志, 2010, 28(4):369-374.
16. 羅從風, 陳健, 孫輝. 脛骨平臺后柱骨折的手術治療. 中華創傷骨科雜志, 2008, 10(9):804-807.

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TREATMENT OF POSTEROLATERAL TIBIAL PLATEAU COLLAPSED AND SPLITED FR ACTURES BY POSTEROMEDIAL AND ANTEROL ATER AL APPROACHES

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