Application of modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZU Bo , WANG Jianjun , LIU Jinrui , CHEN Zhi

Department of Orthopedics, Anqing Hospital, Anhui Medical University, Anqing Anhui, 246003, P.R.China;

Corresponding?author：

ZU Bo, Email: zubo789@sina.com.cn

Keywords：

Modified anterolateral supra-fibular-head approach; tibial plateau fracture; posterolateral column; fracture reduction; internal fixation

DOI：

10.7507/1002-1892.201910010

Video：

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Objective To explore effectiveness of reduction and internal fixation via modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column.Methods Between January 2016 and September 2018, 19 patients diagnosed as tibial plateau fractures involving posterolateral column were treated with reduction and internal fixation via modified anterolateral supra-fibular-head approach. There were 11 males and 8 females with an average age of 43.2 years (range, 28-65 years). The causes of tibial fracture were traffic accident (12 patients), falling injury (5 patients), and falling from height (2 patients). According to the Schatzker typing, the tibial fractures were rated as type Ⅱ in 9 cases, type Ⅲ in 4 cases, type Ⅴ in 4 cases, and type Ⅵ in 2 cases. The time from injury to operation was 5-13 days (mean, 8.5 days). There were 2 patients with osteoporosis. The operation time, intraoperative blood loss, and postoperative complications were recorded. The knee X-ray film was reviewed regularly to observe the fracture healing. At last follow-up, the fracture reductions were evaluated by Rasmussen radiological score. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score system.Results The average operation time was 95 minutes (range, 65-130 minutes). The average intraoperative blood loss was 220 mL (range, 150-350 mL). All incisions healed by first intention. No complications such as infection or deep venous thrombosis occurred. All patients were followed up 12-20 months (mean, 15.4 months). X-ray films showed that the fractures healed with the healing time of 12-20 weeks (mean, 14.5 weeks). No complications such as loosening or breakage of internal fixation occurred. At last follow-up, according to the Rasmussen radiological score, the fracture reductions were evaluated as excellent in 13 cases, good in 4 cases, fair in 1 case, and poor in 1 case. HSS scores of knee joint function were excellent in 14 cases, good in 3 cases, fair in 1 case, and poor in 1 case. The knee joint range of motion was 90°-135°, with an average of 113.4°.Conclusion Application of modified anterolateral supra-fibular-head approach in reduction and internal fixation for tibial plateau fractures involving posterolateral column has the advantages of full exposure, less trauma, safety, and reliable reduction and fixation.

Citation： ZU Bo, WANG Jianjun, LIU Jinrui, CHEN Zhi. Application of modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(6): 702-706. doi: 10.7507/1002-1892.201910010 Copy

1.	Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11): 683-692.
2.	Kokkalis ZT, Iliopoulos ID, Pantazis C, et al. What’s new in the management of complex tibial plateau fractures? Injury, 2016, 47(6): 1162-1169.
3.	Sohn HS, Yoon YC, Cho JW, et al. Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures. J Orthop Trauma, 2015, 29(2): 91-97.
4.	Garner MR, Warner SJ, Lorich DG. Surgical approaches to posterolateral tibial plateau fractures. J Knee Surg, 2016, 29(1): 12-20.
5.	Raza H, Hashmi P, Abbas K, et al. Minmally invasive plate osteosynthesis for tibial plateau fractures. J Orthop Surg (Hong Kong), 2012, 20(1): 42-47.
6.	Anderson AF, Irrgang JJ, Kocher MS, et al. The international knee documentation committee subjective knee evaluation form: normative data. Am J Sports Med, 2006, 34(1): 128-135.
7.	陳昌勝, 戚曉陽, 徐明勇, 等. 累及脛骨平臺后柱骨折的手術療效和并發癥分析. 實用骨科雜志, 2019, 25(3): 205-208.
8.	Bagherifard A, Jabalameli M, Hadi H, et al. Surgical management of tibial plateau fractures with 3.5 mm simple plates. Trauma Mon, 2016, 21(2): e26733.
9.	袁功武, 聶宇, 劉曦明, 等. 3D 打印技術輔助治療與傳統手術方法治療復雜脛骨平臺骨折的對比研究. 創傷外科雜志, 2018, 20(5): 324-328.
10.	王博煒, 余斌. 脛骨平臺骨折三柱分型理論及術前計劃. 國際骨科學雜志, 2017, 38(5): 275-281.
11.	陸圣君, 廖全明, 王克軍. 前外側入路排釘技術治療單純后外側脛骨平臺骨折療效觀察. 中國修復重建外科雜志, 2017, 31(3): 392-384.
12.	Zhao G, He Q, Duan H, et al. Treatment of posterolateral tibial plateau fractures through fibular osteotomy approach. Acta Orthop Belg, 2019, 85(1): 114-121.
13.	Pierrie SN, Harmer LS, Karunakar MA, et al. Limited added value of the posterolateral approach. J Knee Surg, 2016, 29(1): 21-27.
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對比. 中國臨床解剖學雜志, 2015, 33(5): 497-501.
15.	Chen HW, Zhou SH, Liu GD, et al. An extended anterolateral approach for poterolateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc, 2015, 23(12): 3750-3755.
16.	Johnson EE, Timon S, Osuji C. Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures. Clin Orthop Relate Res, 2013, 471(9): 2760-2767.
17.	Yu B, Han K, Zhan C, et al. Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee, 2010, 17(5): 313-318.
18.	Cho JW, Samal P, Jeon YS, et al. Rim plating of posterolateral fracture fragments (PLFs) through a modified anterolateral approach in tibial plateau fractures. J Orthop Trauma, 2016, 30(11): e362-e368.
19.	Hu SJ, Chang SM, Zhang YQ, et al. The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures: A novel surgical technique. Injury, 2016, 47(2): 502-507.
20.	胡孫君, 張世民, 杜守超, 等. 腓骨頭上入路箍鋼板治療脛骨平臺后外側髁骨折. 中國矯形外科雜志, 2019, 27(6): 558-562.
21.	趙允, 胡文晉, 黃競敏, 等. 內側撐開高位脛骨截骨術聯合調整脛骨平臺后傾角治療屈曲受限型膝內翻骨關節炎的早期療效. 中國修復重建外科雜志, 2018, 32(2): 157-161.

1. Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11): 683-692.
2. Kokkalis ZT, Iliopoulos ID, Pantazis C, et al. What’s new in the management of complex tibial plateau fractures? Injury, 2016, 47(6): 1162-1169.
3. Sohn HS, Yoon YC, Cho JW, et al. Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures. J Orthop Trauma, 2015, 29(2): 91-97.
4. Garner MR, Warner SJ, Lorich DG. Surgical approaches to posterolateral tibial plateau fractures. J Knee Surg, 2016, 29(1): 12-20.
5. Raza H, Hashmi P, Abbas K, et al. Minmally invasive plate osteosynthesis for tibial plateau fractures. J Orthop Surg (Hong Kong), 2012, 20(1): 42-47.
6. Anderson AF, Irrgang JJ, Kocher MS, et al. The international knee documentation committee subjective knee evaluation form: normative data. Am J Sports Med, 2006, 34(1): 128-135.
7. 陳昌勝, 戚曉陽, 徐明勇, 等. 累及脛骨平臺后柱骨折的手術療效和并發癥分析. 實用骨科雜志, 2019, 25(3): 205-208.
8. Bagherifard A, Jabalameli M, Hadi H, et al. Surgical management of tibial plateau fractures with 3.5 mm simple plates. Trauma Mon, 2016, 21(2): e26733.
9. 袁功武, 聶宇, 劉曦明, 等. 3D 打印技術輔助治療與傳統手術方法治療復雜脛骨平臺骨折的對比研究. 創傷外科雜志, 2018, 20(5): 324-328.
10. 王博煒, 余斌. 脛骨平臺骨折三柱分型理論及術前計劃. 國際骨科學雜志, 2017, 38(5): 275-281.
11. 陸圣君, 廖全明, 王克軍. 前外側入路排釘技術治療單純后外側脛骨平臺骨折療效觀察. 中國修復重建外科雜志, 2017, 31(3): 392-384.
12. Zhao G, He Q, Duan H, et al. Treatment of posterolateral tibial plateau fractures through fibular osteotomy approach. Acta Orthop Belg, 2019, 85(1): 114-121.
13. Pierrie SN, Harmer LS, Karunakar MA, et al. Limited added value of the posterolateral approach. J Knee Surg, 2016, 29(1): 21-27.
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對比. 中國臨床解剖學雜志, 2015, 33(5): 497-501.
15. Chen HW, Zhou SH, Liu GD, et al. An extended anterolateral approach for poterolateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc, 2015, 23(12): 3750-3755.
16. Johnson EE, Timon S, Osuji C. Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures. Clin Orthop Relate Res, 2013, 471(9): 2760-2767.
17. Yu B, Han K, Zhan C, et al. Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee, 2010, 17(5): 313-318.
18. Cho JW, Samal P, Jeon YS, et al. Rim plating of posterolateral fracture fragments (PLFs) through a modified anterolateral approach in tibial plateau fractures. J Orthop Trauma, 2016, 30(11): e362-e368.
19. Hu SJ, Chang SM, Zhang YQ, et al. The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures: A novel surgical technique. Injury, 2016, 47(2): 502-507.
20. 胡孫君, 張世民, 杜守超, 等. 腓骨頭上入路箍鋼板治療脛骨平臺后外側髁骨折. 中國矯形外科雜志, 2019, 27(6): 558-562.
21. 趙允, 胡文晉, 黃競敏, 等. 內側撐開高位脛骨截骨術聯合調整脛骨平臺后傾角治療屈曲受限型膝內翻骨關節炎的早期療效. 中國修復重建外科雜志, 2018, 32(2): 157-161.

Chinese Journal of Reparative and Reconstructive Surgery

Application of modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column

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