Treatment of posterolateral tibial plateau fractures with a novel lateral tibial plateau annular plate via fibular neck osteotomy approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YU Jinwei , CHEN Haojie , GUO Jiarui , CHEN Xu , WANG Bin

Department of Orthopedics, the First Affiliated Hospital of Henan Polytechnic University, Jiaozuo Henan, 454000, P. R. China;

Corresponding?author：

YU Jinwei, Email: hnwcgk@163.com

Keywords：

Posterolateral tibial plateau fracture; novel lateral tibial plateau annular plate; fibular neck osteotomy approach; internal fixation; knee

DOI：

10.7507/1002-1892.202205107

Video：

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Objective To investigate the effectiveness of a novel lateral tibial plateau annular plate (hereinafter referred to as the novel plate) fixation via fibular neck osteotomy approach for posterolateral tibial plateau fractures. Methods Between January 2015 and December 2018, 22 patients with posterolateral tibial plateau fractures were treated. There were 10 males and 12 females with an average age of 39.0 years (range, 25-56 years). Seven fractures were caused by falls, 10 by traffic accidents, and 5 by falling from height. The time from injury to hospitalization ranged from 3 to 12 days, with an average of 7.0 days. All patients were closed fractures. According to Schatzker classification, the fractures were classified as type Ⅱ in 8 cases, type Ⅲ in 9 cases, type Ⅴ in 1 case, and type Ⅵ in 4 cases. The fractures were fixed with the novel plates after reduction via fibular neck osteotomy approach. The fracture reduction and healing were observed by X-ray film after operation. The range of motion of the knee joint was recorded and the function was evaluated by modified American Hospital for Special Surgery (HSS) score. Results All operations were completed successfully. The operation time was 60-95 minutes (mean, 77.6 minutes). The intraoperative blood loss was 100-520 mL (mean, 214.5 mL). There was 1 case of common peroneal nerve injury during operation and 2 cases of fat liquefaction of incision after operation. All patients were followed up 13-32 months (mean, 19.4 months). Postoperative X-ray films showed that the fracture reduction was good in 17 cases and moderate in 5 cases, and all fractures healed with a healing time of 10-18 weeks (mean, 13.0 weeks). At last follow-up, the range of motion of the knee joint ranged from 100° to 145° in flexion (mean, 125.5°) and from 0° to 4° in extension (mean, 1.2°). The modified HSS score was 82-95 (mean, 86.3). There was no complications such as plate deformation, screw fracture, fracture reduction loss, skin necrosis, and so on. Conclusion For posterolateral tibial plateau fractures, the novel plate fixation via fibular neck osteotomy approach has the advantages of clear intraoperative field, firm fracture fixation, and less postoperative complications, which is beneficial to the recovery of knee joint function.

Citation： YU Jinwei, CHEN Haojie, GUO Jiarui, CHEN Xu, WANG Bin. Treatment of posterolateral tibial plateau fractures with a novel lateral tibial plateau annular plate via fibular neck osteotomy approach. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(9): 1103-1107. doi: 10.7507/1002-1892.202205107 Copy

1.	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.
2.	Meulenkamp B, Martin R, Desy NM, et al. Incidence, risk factors, and location of articular malreductions of the tibial plateau. J Orthop Trauma, 2017, 31(3): 146-150.
3.	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.
4.	祖波, 汪建軍, 劉金銳, 等. 經改良前外側腓骨小頭上入路復位內固定治療累及后外側柱脛骨平臺骨折. 中國修復重建外科雜志, 2020, 34(6): 702-706.
5.	Shen QJ, Zhang JL, Xing GS, et al. Surgical treatment of lateral tibial plateau fractures involving the posterolateral column. Orthop Surg, 2019, 11(6): 1029-1038.
6.	?zdemir G, Yilmaz B, ?irin E, et al. The anatomical relationship of the neurovascular structures in direct posterior lateral gastrocnemius split approach for posterolateral tibial plateau fractures. Eur J Trauma Emerg Surg, 2018, 44(3): 427-432.
7.	Pires RES, Giordano V, Wajnsztejn A, et al. Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau. Injury, 2016, 47(10): 2320-2325.
8.	DeCoster TA, Willis MC, Marsh JL, et al. Rank order analysis of tibial plafond fractures: does injury or reduction predict outcome? Foot Ankle Int, 1999, 20(1): 44-49.
9.	Insall JN, Dorr LD, Scott RD, et al. Rationale of the knee society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
10.	汪國棟, 劉培釗, 劉曦明. 后外側脛骨平臺骨折手術入路之熱點問題探討. 創傷外科雜志, 2021, 23(10): 721-727.
11.	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.
12.	Cai P, Yuan M, Ji H, et al. The treatment of posterolateral tibial plateau fracture with a newly designed anatomical plate via the trans-supra-fibular head approach: preliminary outcomes. BMC Musculoskelet Disord, 2021, 22(1): 804. doi: 10.1186/s12891-021-04684-w.
13.	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.
14.	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.
15.	牟斌. 觀察后外側聯合后內側入路治療脛骨平臺后柱骨折的效果. 中國繼續醫學教育, 2018, 10(8): 100-101.
16.	尚延春, 孟慶陽, 柴巍巍. 腓骨頸截骨入路切開復位鋼板內固定治療脛骨平臺后外側骨折. 中醫正骨, 2018, 30(1): 55-58.
17.	齊向陽, 林錦秀, 尹德超, 等. 前外側聯合后內側入路與腓骨頭截骨入路治療累及脛骨平臺后外側平臺骨折的療效分析. 中國骨與關節雜志, 2021, 10(8): 618-623.
18.	Zhang W, Luo CF, Putnis S, et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee, 2012, 19(2): 94-98.
19.	Hu S, Chen S, Chang S, et al. Treatment of isolated posterolateral tibial plateau fracture with a horizontal belt plate through the anterolateral supra-fibular-head approach. Biomed Res Int, 2020, 2020: 4186712. doi: 10.1155/2020/4186712.
20.	Sassoon AA, Torchia ME, Cross WW, et al. Fibular shaft allograft support of posterior joint depression in tibial plateau fractures. J Orthop Trauma, 2014, 28(7): e169-e175.
21.	Sun H, He QF, Zhang BB, et al. A biomechanical evaluation of different fixation strategies for posterolateral fragments in tibial plateau fractures and introduction of the ‘magic screw’. Knee, 2018, 25(3): 417-426.

1. 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.
2. Meulenkamp B, Martin R, Desy NM, et al. Incidence, risk factors, and location of articular malreductions of the tibial plateau. J Orthop Trauma, 2017, 31(3): 146-150.
3. 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.
4. 祖波, 汪建軍, 劉金銳, 等. 經改良前外側腓骨小頭上入路復位內固定治療累及后外側柱脛骨平臺骨折. 中國修復重建外科雜志, 2020, 34(6): 702-706.
5. Shen QJ, Zhang JL, Xing GS, et al. Surgical treatment of lateral tibial plateau fractures involving the posterolateral column. Orthop Surg, 2019, 11(6): 1029-1038.
6. ?zdemir G, Yilmaz B, ?irin E, et al. The anatomical relationship of the neurovascular structures in direct posterior lateral gastrocnemius split approach for posterolateral tibial plateau fractures. Eur J Trauma Emerg Surg, 2018, 44(3): 427-432.
7. Pires RES, Giordano V, Wajnsztejn A, et al. Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau. Injury, 2016, 47(10): 2320-2325.
8. DeCoster TA, Willis MC, Marsh JL, et al. Rank order analysis of tibial plafond fractures: does injury or reduction predict outcome? Foot Ankle Int, 1999, 20(1): 44-49.
9. Insall JN, Dorr LD, Scott RD, et al. Rationale of the knee society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
10. 汪國棟, 劉培釗, 劉曦明. 后外側脛骨平臺骨折手術入路之熱點問題探討. 創傷外科雜志, 2021, 23(10): 721-727.
11. 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.
12. Cai P, Yuan M, Ji H, et al. The treatment of posterolateral tibial plateau fracture with a newly designed anatomical plate via the trans-supra-fibular head approach: preliminary outcomes. BMC Musculoskelet Disord, 2021, 22(1): 804. doi: 10.1186/s12891-021-04684-w.
13. 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.
14. 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.
15. 牟斌. 觀察后外側聯合后內側入路治療脛骨平臺后柱骨折的效果. 中國繼續醫學教育, 2018, 10(8): 100-101.
16. 尚延春, 孟慶陽, 柴巍巍. 腓骨頸截骨入路切開復位鋼板內固定治療脛骨平臺后外側骨折. 中醫正骨, 2018, 30(1): 55-58.
17. 齊向陽, 林錦秀, 尹德超, 等. 前外側聯合后內側入路與腓骨頭截骨入路治療累及脛骨平臺后外側平臺骨折的療效分析. 中國骨與關節雜志, 2021, 10(8): 618-623.
18. Zhang W, Luo CF, Putnis S, et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee, 2012, 19(2): 94-98.
19. Hu S, Chen S, Chang S, et al. Treatment of isolated posterolateral tibial plateau fracture with a horizontal belt plate through the anterolateral supra-fibular-head approach. Biomed Res Int, 2020, 2020: 4186712. doi: 10.1155/2020/4186712.
20. Sassoon AA, Torchia ME, Cross WW, et al. Fibular shaft allograft support of posterior joint depression in tibial plateau fractures. J Orthop Trauma, 2014, 28(7): e169-e175.
21. Sun H, He QF, Zhang BB, et al. A biomechanical evaluation of different fixation strategies for posterolateral fragments in tibial plateau fractures and introduction of the ‘magic screw’. Knee, 2018, 25(3): 417-426.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of posterolateral tibial plateau fractures with a novel lateral tibial plateau annular plate via fibular neck osteotomy approach

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