Short-term effectiveness of staged management in treatment of complex tibial plateau fracture with severe soft tissue injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HONG Guqi , Lü Tianrun , CHEN Qun , SONG Lijun , HUANG Xiaowen ,  ZUO Qiang

Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210029, P. R. China;

Corresponding?author：

ZUO Qiang, Email: zuoqiang1985@nimu.edu.cn

Keywords：

Tibial plateau fracture; soft tissue injury; staged management; internal fixation; short-term effectiveness

DOI：

10.7507/1002-1892.202205080

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Objective To evaluate short-term effectiveness of staged management for complex tibial plateau fracture with severe soft tissue injury. Methods A clinical data of 12 patients with complex tibial plateau fractures and severe soft tissue injuries between July 2017 and March 2021 and met the selection criteria was retrospectively analyzed. There were 7 males and 5 females with an average age of 43.1 years (range, 33-58 years). All patients were traffic accident injuries and admitted to hospital within 24 hours after injury. The tibial plateau fractures were closed fractures. According to the Schatzker classification standard, the fractures were rated as type Ⅳ in 3 cases, type Ⅴ in 4 cases, and type Ⅵ in 5 cases. According to the Tscherne classification standard, the soft tissue injuries were rated as grade Ⅱ in 4 cases and grade Ⅲ in 8 cases. The treatment of all patients was divided into 3 stages. In the first stage, emergency trans-articular fracture fixation with external fixator was performed; in the second stage, the fracture reduction and internal fixation were performed and bone cement was implanted to fill the bone defect; in the third stage, the bone cement was removed and the bone graft was performed to repair defect. All patients performed joint function exercise after operation as early as possible. Results There was no neurological symptom after all staged managements, the incisions healed by first intention, and no complications such as incision infection or necrosis occurred. All patients were followed up 6-32 months (mean, 16.9 months). The fractures were all anatomical reduction confirmed by the X-ray films after operation. During follow-up, there was no obvious loss of reduction, loosening and rupture of internal fixator, or collapse of the articular surface. All fractures healed after 14-20 weeks (mean, 17.6 weeks). The posterior slope angle of the tibial plateau was (9.7±2.3)° and the varus angle was (3.9±1.9)° immediately after bone grafting, and were (8.5±2.9)° and (4.3±1.9)° respectively at 6 months after operation. There was no significant difference between the two time points (t=0.658, P=0.514; t=?1.167, P=0.103). At last follow-up, the Hospital for Special Surgery (HSS) score was 85-96 (mean, 91.2), and the range of motion of knee was 110°-135° (mean, 120.9°). Conclusion The staged management for complex tibial plateau fracture with severe soft tissue injury can obtain good short-term effectiveness, but the long-term effectiveness needs to be further followed up.

Citation： HONG Guqi, Lü Tianrun, CHEN Qun, SONG Lijun, HUANG Xiaowen, ZUO Qiang. Short-term effectiveness of staged management in treatment of complex tibial plateau fracture with severe soft tissue injury. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(10): 1249-1254. doi: 10.7507/1002-1892.202205080 Copy

1.	Bertrand ML, Pascual-López FJ, Guerado E. Severe tibial plateau fractures (Schatzker Ⅴ-Ⅵ): open reduction and internal fixation versus hybrid external fixation. Injury, 2017, 48 Suppl 6: S81-S85.
2.	Giordano V, do Amaral NP, Koch HA, et al. Outcome evaluation of staged treatment for bicondylar tibial plateau fractures. Injury, 2017, 48 Suppl 4: S34-S40.
3.	Spagnolo R, Pace F. Management of the Schatzker Ⅵ fractures with lateral locked screw plating. Musculoskelet Surg, 2012, 96(2): 75-80.
4.	Ryu SM, Yang HS, Shon OJ. Staged treatment of bicondylar tibial plateau fracture (Schatzker type Ⅴ or Ⅵ) using temporary external fixator: correlation between clinical and radiological outcomes. Knee Surg Relat Res, 2018, 30(3): 261-268.
5.	許勝貴, 郭衛中, 林旺, 等. 復雜脛骨平臺骨折切開復位鎖定鋼板內固定術后療效觀察. 中國骨與關節損傷雜志, 2020, 35(6): 625-627.
6.	Tao X, Chen N, Pan F, et al. External fixation combined with delayed internal fixation in treatment of tibial plateau fractures with dislocation. Medicine (Baltimore), 2017, 96(41): e8221. doi: 10.1097/MD.0000000000008221.
7.	許巖, 段德宇, 劉國輝, 等. 關節鏡輔助復位內固定與切開復位內固定治療脛骨平臺骨折的療效比較. 中華創傷骨科雜志, 2021, 23(2): 116-120.
8.	龔有兵, 何成文, 孫大連, 等. 關節鏡輔助下內固定治療后外側脛骨平臺骨折的臨床研究. 創傷外科雜志, 2022, 24(2): 133-137.
9.	齊欣, 徐永清, 夏燊, 等. 單純Ilizarov環形外固定技術治療合并骨筋膜室綜合征的脛骨平臺骨折. 中國修復重建外科雜志, 2020, 34(10): 1248-1252.
10.	陳農, 馬易群, 周凱華, 等. 臨時跨關節外固定支架固定聯合延期內固定治療復雜脛骨平臺骨折. 中華創傷骨科雜志, 2016, 18(4): 312-317.
11.	黃曉文, 洪顧麒, 呂天潤, 等. 早期應用跨關節外固定支架減輕SchatzkerⅥ型脛骨平臺骨折周圍軟組織損傷的臨床研究. 創傷外科雜志, 2021, 23(6): 406-411.
12.	呂戰虎, 王良勇, 宋慶華, 等. 分期誘導膜與脛骨滑移植骨治療感染性距骨缺損. 中國矯形外科雜志, 2022, 30(9): 831-834.
13.	周敏, 簡超, 李宗煥, 等. 開放性骨水泥技術治療感染性骨及軟組織復合缺損的療效分析. 中華顯微外科雜志, 2022, 45(2): 121-127.
14.	Pruzansky ME, Lee Y, Pruzansky J. Masquelet technique for phalangeal reconstruction and osteomyelitis. Tech Hand Up Extrem Surg, 2020, 25(1): 52-55.
15.	Higgins TF, Klatt J, Bachus KN. Biomechanical analysis of bicondylar tibial plateau fixation: how does lateral locking plate fixation compare to dual plate fixation? J Orthop Trauma, 2007, 21(5): 301-306.
16.	Lee TC, Huang HT, Lin YC, et al. Bicondylar tibial plateau fracture treated by open reduction and fixation with unilateral locked plating. Kaohsiung J Med Sci, 2013, 29(10): 568-577.
17.	Veitch SW, Stroud RM, Toms AD. Compaction bone grafting in tibial plateau fracture fixation. J Trauma, 2010, 68(4): 980-983.
18.	位鋒, 周業金, 姚濤, 等. SchatzkerⅡ型脛骨平臺骨折切開復位內固定聯合自體髂骨植骨或固體硫酸鈣植骨的療效比較. 中國骨與關節損傷雜志, 2021, 36(2): 191-193.
19.	Milenkovic S, Mitkovic M, Mitkovic M, et al. Lateral tibial plateau fractures-functional outcomes and complications after open reduction and internal fixation. Int Orthop, 2021, 45(4): 1071-1076.
20.	呂紅芝, 侯志勇, 王娟, 等. 脛骨平臺骨折合并髁間棘骨折術后患者膝關節功能恢復的相關因素分析. 中華創傷骨科雜志, 2021, 23(2): 132-137.
21.	中華創傷骨科雜志編輯委員會. 脛骨平臺骨折診斷與治療的專家共識. 中華創傷骨科雜志, 2015, 17(1): 3-7.

1. Bertrand ML, Pascual-López FJ, Guerado E. Severe tibial plateau fractures (Schatzker Ⅴ-Ⅵ): open reduction and internal fixation versus hybrid external fixation. Injury, 2017, 48 Suppl 6: S81-S85.
2. Giordano V, do Amaral NP, Koch HA, et al. Outcome evaluation of staged treatment for bicondylar tibial plateau fractures. Injury, 2017, 48 Suppl 4: S34-S40.
3. Spagnolo R, Pace F. Management of the Schatzker Ⅵ fractures with lateral locked screw plating. Musculoskelet Surg, 2012, 96(2): 75-80.
4. Ryu SM, Yang HS, Shon OJ. Staged treatment of bicondylar tibial plateau fracture (Schatzker type Ⅴ or Ⅵ) using temporary external fixator: correlation between clinical and radiological outcomes. Knee Surg Relat Res, 2018, 30(3): 261-268.
5. 許勝貴, 郭衛中, 林旺, 等. 復雜脛骨平臺骨折切開復位鎖定鋼板內固定術后療效觀察. 中國骨與關節損傷雜志, 2020, 35(6): 625-627.
6. Tao X, Chen N, Pan F, et al. External fixation combined with delayed internal fixation in treatment of tibial plateau fractures with dislocation. Medicine (Baltimore), 2017, 96(41): e8221. doi: 10.1097/MD.0000000000008221.
7. 許巖, 段德宇, 劉國輝, 等. 關節鏡輔助復位內固定與切開復位內固定治療脛骨平臺骨折的療效比較. 中華創傷骨科雜志, 2021, 23(2): 116-120.
8. 龔有兵, 何成文, 孫大連, 等. 關節鏡輔助下內固定治療后外側脛骨平臺骨折的臨床研究. 創傷外科雜志, 2022, 24(2): 133-137.
9. 齊欣, 徐永清, 夏燊, 等. 單純Ilizarov環形外固定技術治療合并骨筋膜室綜合征的脛骨平臺骨折. 中國修復重建外科雜志, 2020, 34(10): 1248-1252.
10. 陳農, 馬易群, 周凱華, 等. 臨時跨關節外固定支架固定聯合延期內固定治療復雜脛骨平臺骨折. 中華創傷骨科雜志, 2016, 18(4): 312-317.
11. 黃曉文, 洪顧麒, 呂天潤, 等. 早期應用跨關節外固定支架減輕SchatzkerⅥ型脛骨平臺骨折周圍軟組織損傷的臨床研究. 創傷外科雜志, 2021, 23(6): 406-411.
12. 呂戰虎, 王良勇, 宋慶華, 等. 分期誘導膜與脛骨滑移植骨治療感染性距骨缺損. 中國矯形外科雜志, 2022, 30(9): 831-834.
13. 周敏, 簡超, 李宗煥, 等. 開放性骨水泥技術治療感染性骨及軟組織復合缺損的療效分析. 中華顯微外科雜志, 2022, 45(2): 121-127.
14. Pruzansky ME, Lee Y, Pruzansky J. Masquelet technique for phalangeal reconstruction and osteomyelitis. Tech Hand Up Extrem Surg, 2020, 25(1): 52-55.
15. Higgins TF, Klatt J, Bachus KN. Biomechanical analysis of bicondylar tibial plateau fixation: how does lateral locking plate fixation compare to dual plate fixation? J Orthop Trauma, 2007, 21(5): 301-306.
16. Lee TC, Huang HT, Lin YC, et al. Bicondylar tibial plateau fracture treated by open reduction and fixation with unilateral locked plating. Kaohsiung J Med Sci, 2013, 29(10): 568-577.
17. Veitch SW, Stroud RM, Toms AD. Compaction bone grafting in tibial plateau fracture fixation. J Trauma, 2010, 68(4): 980-983.
18. 位鋒, 周業金, 姚濤, 等. SchatzkerⅡ型脛骨平臺骨折切開復位內固定聯合自體髂骨植骨或固體硫酸鈣植骨的療效比較. 中國骨與關節損傷雜志, 2021, 36(2): 191-193.
19. Milenkovic S, Mitkovic M, Mitkovic M, et al. Lateral tibial plateau fractures-functional outcomes and complications after open reduction and internal fixation. Int Orthop, 2021, 45(4): 1071-1076.
20. 呂紅芝, 侯志勇, 王娟, 等. 脛骨平臺骨折合并髁間棘骨折術后患者膝關節功能恢復的相關因素分析. 中華創傷骨科雜志, 2021, 23(2): 132-137.
21. 中華創傷骨科雜志編輯委員會. 脛骨平臺骨折診斷與治療的專家共識. 中華創傷骨科雜志, 2015, 17(1): 3-7.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of staged management in treatment of complex tibial plateau fracture with severe soft tissue injury

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