Osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in treatment of tibial plateau fractures involving posterolateral column collapse_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PEI Xuan ^1,2 , WANG Guodong ¹ ^△ , QIAN Shenglong ¹ , CHENG Yipeng ^1,2 , FANG Zhixun ^1,3 , KE Xi ¹ ,  LIU Ximing ¹

1. Department of Orthopedics, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430070, P. R. China;
2. School of Medicine, Wuhan University of Science and Technology, Wuhan Hubei, 430081, P. R. China;
3. First School of Clinical Medicine, Southern Medical University, Guangzhou Guangdong, 510515, P. R. China;

Corresponding?author：

LIU Ximing, Email: gklxm@163.com

Keywords：

Tibial plateau fracture; osteotomy; reduction; internal fixation

DOI：

10.7507/1002-1892.202301019

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Objective To investigate the effectiveness of osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in the treatment of tibial plateau fractures involving posterolateral column collapse. Methods A clinical data of 23 patients with tibial plateau fractures involving posterolateral column collapse, who had undergone osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation between January 2015 and June 2021, was retrospectively analyzed. There were 14 males and 9 females with an average age of 42.6 years ranging from 26 to 62 years. The causes of injury included traffic accident in 16 cases, falling from height in 5 cases, and other injuries in 2 cases. According to Schatzker classification, there were 15 cases of type Ⅴ and 8 cases of type Ⅵ. The time from injury to operation was 4-8 days with an average of 5.9 days. The operation time, intraoperative blood loss, fracture healing time, and complications were recorded. The depth of articular surface collapse of posterolateral column and posterior inclination angle (PSA) of the tibial plateau were compared before operation and at 2 days and 6 months after operation; fracture reduction of tibial plateau fracture was evaluated by Rasmussen anatomic score. The recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score at 2 days and 6 months after operation. Results All 23 patients were completed the operation successfully. The operation time was 120-195 minutes, with an average of 152.8 minutes; the intraoperative blood loss was 50-175 mL, with an average of 109.5 mL. All patients were followed up 12-24 months, with an average of 16.7 months. One patient had superficial wound infection after operation, and the incision healed after dressing change; primary healing of incision of other patients was obtained. The fracture healing time was 12-18 weeks, with an average of 13.7 weeks. No failure of internal fixation, varus and valgus deformity of the knee joint, and instability of the knee joint was found at last follow-up. One patient developed joint stiffness and the range of motion of the knee joint was 10°-100°; the range of motion of the knee joint of other patients was 0°-125°. At 2 days and 6 months after operation, the depth of articular surface collapse of posterolateral column, PSA, and Rasmussen anatomic scores significantly improved when compared with those before operation (P<0.05). There was no significant difference between the two postoperative time points (P>0.05). The HSS score at 6 months after operation was significantly higher than that at 2 days after operation (P<0.05). Conclusion For tibial plateau fractures involving posterolateral column collapse, reduction and internal fixation through osteotomy of non-core weight-bearing area of the lateral tibial plateau has the advantages of fully expose the posterolateral column fragment, good articular surface reduction, sufficient bone grafting, and fewer postoperative complications. It is beneficial to restore knee joint function and can be widely used in clinic.

Citation： PEI Xuan, WANG Guodong, QIAN Shenglong, CHENG Yipeng, FANG Zhixun, KE Xi, LIU Ximing. Osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in treatment of tibial plateau fractures involving posterolateral column collapse. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 410-416. doi: 10.7507/1002-1892.202301019 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.	Zhang Y, Song L, Li X, et al. Flexion-valgus unicondylar tibial plateau depression fracture pattern: Classification and treatment. Injury, 2018, 49(4): 852-859.
3.	Sim JA, Park JH, Na YG, et al. Three-column subdivision for isolated posterolateral tibial plateau fractures and perspective surgical approaches. Knee, 2021, 33: 93-101.
4.	Wang Y, Luo C, Zhu Y, et al. Updated three-column concept in surgical treatment for tibial plateau fractures-A prospective cohort study of 287 patients. Injury, 2016, 47(7): 1488-1496.
5.	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.
6.	Cho JW, Kim J, Cho WT, et al. Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures: a review with an emphasis on rim plating via modified anterolateral approach. Int Orthop, 2017, 41(9): 1887-1897.
7.	胡孫君, 杜守超, 李世杰, 等. 脛骨平臺后外側骨折的手術入路與內固定治療技術的研究進展. 國際骨科學雜志, 2022, 43(1): 12-17.
8.	明安世, 汪潔, 朱登峰, 等. 選擇性脛骨外髁U形截骨入路治療脛骨外側平臺塌陷粉碎骨折. 中國骨傷, 2022, 35(6): 560-565.
9.	焦競, 黃玉成, 肖飛, 等. 3D打印截骨導板結合 “柵欄” 螺釘技術治療涉及外后髁塌陷的脛骨平臺骨折. 中華骨科雜志, 2022, 42(18): 1204-1211.
10.	焦競, 肖飛, 黃玉成, 等. 3D打印結合脛骨外髁截骨治療脛骨平臺外后髁骨折. 中華骨科雜志, 2018, 38(15): 913-918.
11.	朱燕賓, 陳偉, 張奇, 等. 脛骨平臺核心負重區的概念及其臨床意義. 中華骨科雜志, 2021, 41(3): 137-140.
12.	Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
13.	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.
14.	Sciadini MF, Sims SH. Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type Ⅳ tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma, 2013, 27(1): e18-e23.
15.	Oeckenp?hler S, Domnick C, Raschke MJ, et al. A lateral fracture step-off of 2mm increases intra-articular pressure following tibial plateau fracture. Injury, 2022, 53(3): 1254-1259.
16.	Tarng YW, Lin KC. A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury. Injury, 2019, 50(10): 1756-1763.
17.	孔祥如, 楊春, 單宇宙, 等. 脛骨近端外側鎖定接骨板排筏螺釘聯合Jail螺釘治療脛骨平臺外側塌陷骨折. 中華創傷雜志, 2022, 38(6): 510-516.

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. Zhang Y, Song L, Li X, et al. Flexion-valgus unicondylar tibial plateau depression fracture pattern: Classification and treatment. Injury, 2018, 49(4): 852-859.
3. Sim JA, Park JH, Na YG, et al. Three-column subdivision for isolated posterolateral tibial plateau fractures and perspective surgical approaches. Knee, 2021, 33: 93-101.
4. Wang Y, Luo C, Zhu Y, et al. Updated three-column concept in surgical treatment for tibial plateau fractures-A prospective cohort study of 287 patients. Injury, 2016, 47(7): 1488-1496.
5. 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.
6. Cho JW, Kim J, Cho WT, et al. Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures: a review with an emphasis on rim plating via modified anterolateral approach. Int Orthop, 2017, 41(9): 1887-1897.
7. 胡孫君, 杜守超, 李世杰, 等. 脛骨平臺后外側骨折的手術入路與內固定治療技術的研究進展. 國際骨科學雜志, 2022, 43(1): 12-17.
8. 明安世, 汪潔, 朱登峰, 等. 選擇性脛骨外髁U形截骨入路治療脛骨外側平臺塌陷粉碎骨折. 中國骨傷, 2022, 35(6): 560-565.
9. 焦競, 黃玉成, 肖飛, 等. 3D打印截骨導板結合 “柵欄” 螺釘技術治療涉及外后髁塌陷的脛骨平臺骨折. 中華骨科雜志, 2022, 42(18): 1204-1211.
10. 焦競, 肖飛, 黃玉成, 等. 3D打印結合脛骨外髁截骨治療脛骨平臺外后髁骨折. 中華骨科雜志, 2018, 38(15): 913-918.
11. 朱燕賓, 陳偉, 張奇, 等. 脛骨平臺核心負重區的概念及其臨床意義. 中華骨科雜志, 2021, 41(3): 137-140.
12. Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
13. 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.
14. Sciadini MF, Sims SH. Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type Ⅳ tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma, 2013, 27(1): e18-e23.
15. Oeckenp?hler S, Domnick C, Raschke MJ, et al. A lateral fracture step-off of 2mm increases intra-articular pressure following tibial plateau fracture. Injury, 2022, 53(3): 1254-1259.
16. Tarng YW, Lin KC. A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury. Injury, 2019, 50(10): 1756-1763.
17. 孔祥如, 楊春, 單宇宙, 等. 脛骨近端外側鎖定接骨板排筏螺釘聯合Jail螺釘治療脛骨平臺外側塌陷骨折. 中華創傷雜志, 2022, 38(6): 510-516.

Chinese Journal of Reparative and Reconstructive Surgery

Osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in treatment of tibial plateau fractures involving posterolateral column collapse

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