Posterolateral minimal incision, poking reduction, and simple internal fixation in treatment of collapsed fractures of posterolateral tibial plateau_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 TU Yonggang ^1,2 , REN Shaodong ² , YE Bolin ² , MA Bangxing ² , ZHANG Shifei ² , YUAN Haobin ²

1. Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
2. No.1 Department of Orthopedics, Changping Hospital of Dongguan, Dongguan Guangdong, 523573, P.R.China;

Corresponding?author：

TU Yonggang, Email: 94665961@qq.com

Keywords：

Posterolateral tibial plateau fracture; collapsed fracture; poking reduction; internal fixation

DOI：

10.7507/1002-1892.201702037

Video：

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Objective To explore the effectiveness of limited incision, poking reduction, and simple internal fixation in the treatment of collapsed fractures of the posterolateral tibial plateau. Methods Between October 2010 and January 2016, 16 patients with collapsed fractures of the posterolateral tibial plateau underwent posterolateral incision, poking reduction, and simple internal fixation. There were 10 males and 6 females with the age of 22-63 years (mean, 43.5 years). The injury was caused by falling in 5 cases, traffic accident in 7 cases, and falling from height in 4 cases. All cases had closed fractures. The left knee was involved in 9 cases and the right knee in 7 cases. The injury-to-admission time was 2 hours to 3 days (mean, 10 hours). X-ray films showed that the articular surface collapsing was more than 2 mm. According to Schatzker criteria, 6 cases were rated as type II and 10 cases as type III. Twelve cases had fracture of fibular head. The incision length, operation time, intraoperative blood loss, and incision healing were recorded; fracture healing was observed, and tibial plateau angle and posterior slope angle were measured on X-ray films; loss of articular surface reduction was observed by CT scan; and American Hospital for Special Surgery (HSS) score was used to evaluate the knee joint function. Results The incision length was 7-10 cm (mean, 8.6 cm); operation time was 35-55 minutes (mean, 46 minutes); intraoperative blood loss was 10-35 mL (mean, 28 mL). Primary healing of incision was obtained. Skin pain occurred in 1 case at 2 months because Kirschner wire retracted. Fifteen cases were followed up 8-21 months (mean, 13.5 months). The fracture healing time was from 3 to 6 months (mean, 4.8 months). There was no significant difference in tibial plateau angle and posterior slope angle between at immediate after operation and at last follow-up (t=–1.500, P=0.156; t=–1.781, P=0.097). The anatomic reduction rate of articular surface was 93.8% (15/16) at immediate after operation. At last follow-up, the recollapse height of articular surface was 0.1-1.2 mm (mean, 0.36 mm). According to the HSS score system, the results were excellent in 12 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 93.3%. Conclusion The limited incision by posterolateral approach, poking reduction, and simple internal fixation have the advantages of small injury, full exposure, and easy operation in the treatment of simple posterolateral tibial plateau fractures; bone graft support and simple internal fixation can prevent recollapse of the articular surface and achieve satisfactory knee function.

Citation： TU Yonggang, REN Shaodong, YE Bolin, MA Bangxing, ZHANG Shifei, YUAN Haobin. Posterolateral minimal incision, poking reduction, and simple internal fixation in treatment of collapsed fractures of posterolateral tibial plateau. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 810-814. doi: 10.7507/1002-1892.201702037 Copy

1.	Elsoe R, Larsen P, Nielsen NP, et al. Population-based epidemiology of tibial plateau fractures. Orthopedics, 2015, 38(9): e780-e786.
2.	Sferopoulos NK. Autograft transfer from the ipsilateral femoral condyle in depressed tibial plateau fracture. Open Orthop J, 2014, 8: 310-315.
3.	Zhai Q, Luo C, Zhu Y, et al. Morphological characteristics of split-depression fractures of the lateral tibial plateau (Schatzker type II): a computer-tomography-based study. Int Orthop, 2013, 37(5): 911-917.
4.	Xiang G, Zhi-Jun P, Qiang Z, et al. Morphological characteristics of posterolateral articular fragments in tibial plateau fractures. Orthopedics, 2013, 36(10): e1256-e1261.
5.	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.
6.	Chang SM. Selection of surgical approaches to the posterolateral tibial plateau fracture by its combination patterns. J Orthop Trauma, 2011, 25(3): e32-e33.
7.	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.
8.	Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Relat Res, 1988, (230): 83-97.
9.	羅東斌, 張永, 湯永南, 等. 雙切口雙鋼板內固定與單側鎖定鋼板內固定治療復雜脛骨平臺骨折的療效比較. 中國老年學雜志, 2016, 36(6): 1413-1415.
10.	楊光輝, 楊太明, 朱裕成, 等. 脛骨平臺后髁骨折的手術治療. 中國矯形外科雜志, 2015, 23(14): 1272-1275.
11.	李煜, 劉玉民, 張寧, 等. 脛骨平臺骨折 Schatzker 分型與膝關節功能相關性分析. 重慶醫學, 2016, 45(12): 1629-1631.
12.	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.
13.	張峻, 張里程, 唐佩福. 脛骨平臺后外側髁骨折手術入路綜述. 解放軍醫學院學報, 2016, 37(8): 905-907.
14.	胡孫君, 張世民, 張英琪, 等. 脛骨平臺后外側象限骨折手術入路的深層解剖及后外側與后內側比較. 中國臨床解剖學雜志, 2015, 33(5): 497-501.
15.	Hu SJ, Chang SM, Zhang YQ, et al. The anterolateral supra-fibular-head approach for plating posterolateral tibial palteau fractures: A novel surgical technique. Injury, 2016, 47(2): 502-507.
16.	Chang SM, Zheng HP, Li HF, et al. Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg, 2009, 129(7): 955-962.
17.	李景光, 徐名洪, 黃愛民, 等. 有限切開撬撥復位三柱固定治療復雜脛骨平臺骨折. 中國矯形外科雜志, 2016, 24(6): 485-490.
18.	卓日波, 黃東, 黃國英, 等. 結構性異體骨移植治療塌陷型脛骨平臺骨折的效果. 廣東醫學, 2014, 35(23): 3678-3680.
19.	劉志祥, 李玉前, 王曉東, 等. 后外側入路治療單純脛骨后外側平臺骨折. 江蘇醫藥, 2015, 41(23): 2891-2892.
20.	陳奇, 徐曉峰, 黃永輝, 等. 膝關節囊外復位內固定治療脛骨平臺骨折的療效觀察. 中國修復重建外科雜志, 2014, 28(12): 1464-1468.

1. Elsoe R, Larsen P, Nielsen NP, et al. Population-based epidemiology of tibial plateau fractures. Orthopedics, 2015, 38(9): e780-e786.
2. Sferopoulos NK. Autograft transfer from the ipsilateral femoral condyle in depressed tibial plateau fracture. Open Orthop J, 2014, 8: 310-315.
3. Zhai Q, Luo C, Zhu Y, et al. Morphological characteristics of split-depression fractures of the lateral tibial plateau (Schatzker type II): a computer-tomography-based study. Int Orthop, 2013, 37(5): 911-917.
4. Xiang G, Zhi-Jun P, Qiang Z, et al. Morphological characteristics of posterolateral articular fragments in tibial plateau fractures. Orthopedics, 2013, 36(10): e1256-e1261.
5. 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.
6. Chang SM. Selection of surgical approaches to the posterolateral tibial plateau fracture by its combination patterns. J Orthop Trauma, 2011, 25(3): e32-e33.
7. 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.
8. Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Relat Res, 1988, (230): 83-97.
9. 羅東斌, 張永, 湯永南, 等. 雙切口雙鋼板內固定與單側鎖定鋼板內固定治療復雜脛骨平臺骨折的療效比較. 中國老年學雜志, 2016, 36(6): 1413-1415.
10. 楊光輝, 楊太明, 朱裕成, 等. 脛骨平臺后髁骨折的手術治療. 中國矯形外科雜志, 2015, 23(14): 1272-1275.
11. 李煜, 劉玉民, 張寧, 等. 脛骨平臺骨折 Schatzker 分型與膝關節功能相關性分析. 重慶醫學, 2016, 45(12): 1629-1631.
12. 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.
13. 張峻, 張里程, 唐佩福. 脛骨平臺后外側髁骨折手術入路綜述. 解放軍醫學院學報, 2016, 37(8): 905-907.
14. 胡孫君, 張世民, 張英琪, 等. 脛骨平臺后外側象限骨折手術入路的深層解剖及后外側與后內側比較. 中國臨床解剖學雜志, 2015, 33(5): 497-501.
15. Hu SJ, Chang SM, Zhang YQ, et al. The anterolateral supra-fibular-head approach for plating posterolateral tibial palteau fractures: A novel surgical technique. Injury, 2016, 47(2): 502-507.
16. Chang SM, Zheng HP, Li HF, et al. Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg, 2009, 129(7): 955-962.
17. 李景光, 徐名洪, 黃愛民, 等. 有限切開撬撥復位三柱固定治療復雜脛骨平臺骨折. 中國矯形外科雜志, 2016, 24(6): 485-490.
18. 卓日波, 黃東, 黃國英, 等. 結構性異體骨移植治療塌陷型脛骨平臺骨折的效果. 廣東醫學, 2014, 35(23): 3678-3680.
19. 劉志祥, 李玉前, 王曉東, 等. 后外側入路治療單純脛骨后外側平臺骨折. 江蘇醫藥, 2015, 41(23): 2891-2892.
20. 陳奇, 徐曉峰, 黃永輝, 等. 膝關節囊外復位內固定治療脛骨平臺骨折的療效觀察. 中國修復重建外科雜志, 2014, 28(12): 1464-1468.

Chinese Journal of Reparative and Reconstructive Surgery

Posterolateral minimal incision, poking reduction, and simple internal fixation in treatment of collapsed fractures of posterolateral tibial plateau

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