Application of minimally invasive techniques in clinical treatment of tibial plateau fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhongzheng ^1,2,3 , ZHENG Zhanle ^1,2,4 ,  ZHANG Yingze ^1,2,3,4

1. Trauma Emergency Center, Hebei Medical University Third Hospital, Shijiazhuang Hebei, 050051, P. R. China;
2. Knee Preservation Center, Hebei Medical University Third Hospital, Shijiazhuang Hebei, 050051, P. R. China;
3. Hebei Institute of Orthopaedics, Shijiazhuang Hebei, 050051, P. R. China;
4. Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang Hebei, 050051, P. R. China;

Corresponding?author：

ZHANG Yingze, Email: yzling_liu@163.com

Keywords：

Tibial plateau fracture; minimally invasive technique; precise diagnosis and treatment

DOI：

10.7507/1002-1892.202506044

Video：

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Objective To review and evaluate the advantages and disadvantages of minimally invasive treatment techniques for tibial plateau fractures (TPFs), as well as the research progress and limitations. Methods The relevant domestic and international research literature on the minimally invasive treatment of TPFs in recent years was reviewed. The advantages, disadvantages, and clinical efficacy of various technologies were summarized and analyzed, and an outlook on future development trends was provided. Results Surgery remains the primary method for treating displaced TPFs. Although traditional open reduction and internal fixation has advantages such as direct reduction and simplicity of procedure, it has gradually fallen out of favor with clinical orthopedic doctors due to extensive soft tissue removal, excessive bleeding, tissue adhesion, and postoperative complications such as skin infection, fracture nonunion, and joint dysfunction. As medical technology continues to develop, minimally invasive surgery and precise diagnosis and treatment are gradually being introduced to orthopedic trauma. Guided by concepts such as “minimally invasive treatment”, “homeopathic repositioning of fractures”, and “internal compression fixation”, many traction reduction devices, internal fixation devices, minimally invasive reduction techniques, and computer-aided navigation technologies have been widely used in the clinical treatment of TPFs. This has greatly helped to overcome the challenges of intraoperative reduction, secondary reduction loss, and postoperative functional impairment and effectively promoting the adoption of minimally invasive treatment techniques in the clinical treatment of TPFs. Conclusion Minimally invasive treatment techniques have made significant progress in the clinical treatment of TPFs, particularly with regard to the reduction, and have demonstrated unique advantages. While relevant research results have received international recognition, there is still a need for orthopedic scholars to conduct real-world research to further explore the underlying principles and mechanisms of action.

Citation： WANG Zhongzheng, ZHENG Zhanle, ZHANG Yingze. Application of minimally invasive techniques in clinical treatment of tibial plateau fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(7): 783-788. doi: 10.7507/1002-1892.202506044 Copy

1.	張英澤. 臨床創傷骨科流行病學. 北京: 人民衛生出版社, 2014: 290-291.
2.	劉家倫, 張英澤, 鄭占樂. 脛骨平臺骨折內固定生物力學研究進展. 中國修復重建外科雜志, 2024, 38(1): 113-118.
3.	Parkkinen M, Madanat R, Mustonen A, et al. Factors predicting the development of early osteoarthritis following lateral tibial plateau fractures: mid-term clinical and radiographic outcomes of 73 operatively treated patients. Scand J Surg, 2014, 103(4): 256-262.
4.	王博, 王娟, 鄭占樂, 等. 自斷加壓骨栓聯合接骨板治療脛骨平臺骨折的療效. 中華創傷骨科雜志, 2021, 23(2): 111-115.
5.	Miles DT, Colón LF, Wilson AW, et al. Topical antibiotic powder and nonunion risk in surgically treated tibial plateau and pilon fractures. J Am Acad Orthop Surg, 2023, 31(6): e310-e317.
6.	Wang Y, Wang Z, Dong Y, et al. Outcomes after ORIF are similar in young and elderly patients with tibial plateau fractures: A minimum 2-year follow-up study. J Orthop Sci, 2024, 29(1): 292-298.
7.	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.
8.	Wang Z, Zheng Z, Ye P, et al. Treatment of tibial plateau fractures: A comparison of two different operation strategies with medium-term follow up. J Orthop Translat, 2022, 36: 1-7.
9.	張英澤. 順勢復位固定微創治療脛骨平臺骨折. 中華骨科雜志, 2023, 43(22): 1473-1476.
10.	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.
11.	Wang Z, Zheng Z, Wang Y, et al. Unilateral locking plate versus unilateral locking plate combined with compression bolt for SchatzkerⅠ-Ⅳ tibial plateau fractures: a comparative study. Int Orthop, 2022, 46(5): 1133-1143.
12.	Ollivier M, Turati M, Munier M, et al. Balloon tibioplasty for reduction of depressed tibial plateau fractures: Preliminary radiographic and clinical results. Int Orthop, 2016, 40(9): 1961-1966.
13.	孔祥如, 王冰, 楊春, 等. 外側排筏鋼板結合Jail螺釘固定治療累及后外側柱的脛骨平臺塌陷骨折近期療效. 中國修復重建外科雜志, 2023, 37(1): 12-18.
14.	王照東, 段克友, 劉亞軍, 等. 中轉螺釘輔助復位固定技術在Schatzker Ⅴ、Ⅵ型脛骨平臺骨折治療中的應用. 中國修復重建外科雜志, 2025, 39(5): 529-535.
15.	裴璇, 汪國棟, 錢勝龍, 等. 經外側平臺非核心負重區截骨復位內固定治療伴后外側柱塌陷的脛骨平臺骨折. 中國修復重建外科雜志, 2023, 37(4): 410-416.
16.	肖飛, 何文平, 王俊文, 等. 骨科手術機器人輔助下微創治療可間接復位的Schatzker Ⅱ、Ⅲ型脛骨平臺骨折的療效分析. 中華創傷骨科雜志, 2024, 26(7): 604-610.
17.	Ueda H, Suzuki R, Nakazawa A, et al. Toward autonomous collision avoidance for robotic neurosurgery in deep and narrow spaces in the brain. Procedia CIRP, 2017, 65: 110-114.
18.	劉又文. 骨科微創技術的發展概況與展望. 中醫正骨, 2016, 28(3): 1-4.
19.	Zheng G, Nolte LP. Computer-assisted orthopedic surgery: current state and future perspective. Front Surg, 2015, 2: 66. doi: 10.3389/fsurg.2015.00066.
20.	蘇永剛, 孫志彬, 朱罡, 等. 基于體感交互的骨折復位機器人控制方法實驗研究. 中國生物醫學工程學報, 2016, 35(3): 380-384.
21.	朱振中, 鄭國焱, 張長青. 機器人輔助技術在創傷骨科的發展與臨床應用. 中國修復重建外科雜志, 2022, 36(8): 915-922.
22.	Zhu Y, Qin S, Jia Y, et al. Surgeon volume and the risk of deep surgical site infection following open reduction and internal fixation of closed tibial plateau fracture. Int Orthop, 2022, 46(3): 605-614.
23.	Wang Z, Wang Y, Wang Y, et al. Introduction and an analysis of inter- and intra-observer validity to the classification of hoffa-like tibial plateau fractures. Orthop Surg, 2024, 16(1): 132-139.
24.	Martz P, Le Baron M. High-energy tibial plateau fracture. Orthop Traumatol Surg Res, 2025, 111(1S): 104072. doi: 10.1016/j.otsr.2024.104072.
25.	Makaram NS, Param A, Clement ND, et al. Primary versus secondary total knee arthroplasty for tibial plateau fractures in patients aged 55 or over—A systematic review and meta-analysis. J Arthroplasty, 2024, 39(2): 559-567.
26.	Zhao WQ, Li XS, Hua J, et al. Reverse traction with Kirschner wires and bilateral external fixation device combined with minimally invasive plate oseoynthesis technique for tibial plateau fractures of type Schatzker Ⅴ and Ⅵ. Int Orthop, 2023, 47(9): 2327-2336.
27.	Sciadini M, Sims S. 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.
28.	張英澤. 脛骨平臺骨折微創治療策略與進展. 中華創傷骨科雜志, 2017, 19(10): 829-832.
29.	Wang Z, Zhu Y, Deng X, et al. Structural bicortical autologous iliac crest bone graft combined with the tunnel bone tamping method for the depressed tibial plateau fractures. Biomed Res Int, 2021, 2021: 1249734. doi: 10.1155/2021/1249734.
30.	Chang JS, Kayani B, Wallace C, et al. Functional alignment achieves soft-tissue balance in total knee arthroplasty as measured with quantitative sensor-guided technology. Bone Joint J, 2021, 103-B(3): 507-514.
31.	Giordano V, Belangero WD, Sá BA, et al. Plate-screw and screwwasher stability in a Schatzker type-Ⅰlateral tibial plateau fracture: a comparative biomechanical study. Rev Col Bras Cir, 2020, 47: e20202546. doi: 10.1590/0100-6991e-20202546.
32.	劉家倫, 鄭占樂. 脛骨平臺骨折微創手術治療進展. 河北醫科大學學報, 2022, 43(9): 1113-1117.
33.	Yan B, Huang X, Xu Y, et al. A novel locking Buttress plate designed for simultaneous medial and posterolateral tibial plateau fractures: concept and comparative finite element analysis. Orthop Surg, 2023, 15(4): 1104-1116.
34.	Teo AQA, Ng DQK, Ramruttun AK, et al. Standard versus customised locking plates for fixation of schatzker ii tibial plateau fractures. Injury, 2022, 53(2): 676-682.
35.	Kambhampati SBS, Rajagopalan S, Abraham VT, et al. Implant design and its applications in the fixation of osteoporotic bones: newer technologies in nails, plates and external fixators. Indian J Orthop, 2024, 59(3): 280-293.
36.	Liu X, Miramini S, Patel M, et al. Balance between mechanical stability and mechano-biology of fracture healing under volar locking plate. Ann Biomed Eng, 2021, 49(9): 2533-2553.
37.	張英澤. 骨折順勢復位治療體系的建立. 北京: 人民衛生出版社, 2018: 574.
38.	張英澤, 韓志杰, 劉歡, 等. 河北醫科大學第三醫院骨折治療理念與原則. 河北醫科大學學報, 2017, 38(9): 1093-1095.
39.	Wang L, You X, Lotinun S, et al. Mechanical sensing protein PIEZO1 regulates bone homeostasis via osteoblast-osteoclast crosstalk. Nat Commun, 2020, 11(1): 282. doi: 10.1038/s41467-019-14146-6.
40.	Li X, Han L, Nookaew I, et al. Stimulation of Piezo1 by mechanical signals promotes bone anabolism. Elife, 2019, 8: e49631-e49653.

1. 張英澤. 臨床創傷骨科流行病學. 北京: 人民衛生出版社, 2014: 290-291.
2. 劉家倫, 張英澤, 鄭占樂. 脛骨平臺骨折內固定生物力學研究進展. 中國修復重建外科雜志, 2024, 38(1): 113-118.
3. Parkkinen M, Madanat R, Mustonen A, et al. Factors predicting the development of early osteoarthritis following lateral tibial plateau fractures: mid-term clinical and radiographic outcomes of 73 operatively treated patients. Scand J Surg, 2014, 103(4): 256-262.
4. 王博, 王娟, 鄭占樂, 等. 自斷加壓骨栓聯合接骨板治療脛骨平臺骨折的療效. 中華創傷骨科雜志, 2021, 23(2): 111-115.
5. Miles DT, Colón LF, Wilson AW, et al. Topical antibiotic powder and nonunion risk in surgically treated tibial plateau and pilon fractures. J Am Acad Orthop Surg, 2023, 31(6): e310-e317.
6. Wang Y, Wang Z, Dong Y, et al. Outcomes after ORIF are similar in young and elderly patients with tibial plateau fractures: A minimum 2-year follow-up study. J Orthop Sci, 2024, 29(1): 292-298.
7. 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.
8. Wang Z, Zheng Z, Ye P, et al. Treatment of tibial plateau fractures: A comparison of two different operation strategies with medium-term follow up. J Orthop Translat, 2022, 36: 1-7.
9. 張英澤. 順勢復位固定微創治療脛骨平臺骨折. 中華骨科雜志, 2023, 43(22): 1473-1476.
10. 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.
11. Wang Z, Zheng Z, Wang Y, et al. Unilateral locking plate versus unilateral locking plate combined with compression bolt for SchatzkerⅠ-Ⅳ tibial plateau fractures: a comparative study. Int Orthop, 2022, 46(5): 1133-1143.
12. Ollivier M, Turati M, Munier M, et al. Balloon tibioplasty for reduction of depressed tibial plateau fractures: Preliminary radiographic and clinical results. Int Orthop, 2016, 40(9): 1961-1966.
13. 孔祥如, 王冰, 楊春, 等. 外側排筏鋼板結合Jail螺釘固定治療累及后外側柱的脛骨平臺塌陷骨折近期療效. 中國修復重建外科雜志, 2023, 37(1): 12-18.
14. 王照東, 段克友, 劉亞軍, 等. 中轉螺釘輔助復位固定技術在Schatzker Ⅴ、Ⅵ型脛骨平臺骨折治療中的應用. 中國修復重建外科雜志, 2025, 39(5): 529-535.
15. 裴璇, 汪國棟, 錢勝龍, 等. 經外側平臺非核心負重區截骨復位內固定治療伴后外側柱塌陷的脛骨平臺骨折. 中國修復重建外科雜志, 2023, 37(4): 410-416.
16. 肖飛, 何文平, 王俊文, 等. 骨科手術機器人輔助下微創治療可間接復位的Schatzker Ⅱ、Ⅲ型脛骨平臺骨折的療效分析. 中華創傷骨科雜志, 2024, 26(7): 604-610.
17. Ueda H, Suzuki R, Nakazawa A, et al. Toward autonomous collision avoidance for robotic neurosurgery in deep and narrow spaces in the brain. Procedia CIRP, 2017, 65: 110-114.
18. 劉又文. 骨科微創技術的發展概況與展望. 中醫正骨, 2016, 28(3): 1-4.
19. Zheng G, Nolte LP. Computer-assisted orthopedic surgery: current state and future perspective. Front Surg, 2015, 2: 66. doi: 10.3389/fsurg.2015.00066.
20. 蘇永剛, 孫志彬, 朱罡, 等. 基于體感交互的骨折復位機器人控制方法實驗研究. 中國生物醫學工程學報, 2016, 35(3): 380-384.
21. 朱振中, 鄭國焱, 張長青. 機器人輔助技術在創傷骨科的發展與臨床應用. 中國修復重建外科雜志, 2022, 36(8): 915-922.
22. Zhu Y, Qin S, Jia Y, et al. Surgeon volume and the risk of deep surgical site infection following open reduction and internal fixation of closed tibial plateau fracture. Int Orthop, 2022, 46(3): 605-614.
23. Wang Z, Wang Y, Wang Y, et al. Introduction and an analysis of inter- and intra-observer validity to the classification of hoffa-like tibial plateau fractures. Orthop Surg, 2024, 16(1): 132-139.
24. Martz P, Le Baron M. High-energy tibial plateau fracture. Orthop Traumatol Surg Res, 2025, 111(1S): 104072. doi: 10.1016/j.otsr.2024.104072.
25. Makaram NS, Param A, Clement ND, et al. Primary versus secondary total knee arthroplasty for tibial plateau fractures in patients aged 55 or over—A systematic review and meta-analysis. J Arthroplasty, 2024, 39(2): 559-567.
26. Zhao WQ, Li XS, Hua J, et al. Reverse traction with Kirschner wires and bilateral external fixation device combined with minimally invasive plate oseoynthesis technique for tibial plateau fractures of type Schatzker Ⅴ and Ⅵ. Int Orthop, 2023, 47(9): 2327-2336.
27. Sciadini M, Sims S. 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.
28. 張英澤. 脛骨平臺骨折微創治療策略與進展. 中華創傷骨科雜志, 2017, 19(10): 829-832.
29. Wang Z, Zhu Y, Deng X, et al. Structural bicortical autologous iliac crest bone graft combined with the tunnel bone tamping method for the depressed tibial plateau fractures. Biomed Res Int, 2021, 2021: 1249734. doi: 10.1155/2021/1249734.
30. Chang JS, Kayani B, Wallace C, et al. Functional alignment achieves soft-tissue balance in total knee arthroplasty as measured with quantitative sensor-guided technology. Bone Joint J, 2021, 103-B(3): 507-514.
31. Giordano V, Belangero WD, Sá BA, et al. Plate-screw and screwwasher stability in a Schatzker type-Ⅰlateral tibial plateau fracture: a comparative biomechanical study. Rev Col Bras Cir, 2020, 47: e20202546. doi: 10.1590/0100-6991e-20202546.
32. 劉家倫, 鄭占樂. 脛骨平臺骨折微創手術治療進展. 河北醫科大學學報, 2022, 43(9): 1113-1117.
33. Yan B, Huang X, Xu Y, et al. A novel locking Buttress plate designed for simultaneous medial and posterolateral tibial plateau fractures: concept and comparative finite element analysis. Orthop Surg, 2023, 15(4): 1104-1116.
34. Teo AQA, Ng DQK, Ramruttun AK, et al. Standard versus customised locking plates for fixation of schatzker ii tibial plateau fractures. Injury, 2022, 53(2): 676-682.
35. Kambhampati SBS, Rajagopalan S, Abraham VT, et al. Implant design and its applications in the fixation of osteoporotic bones: newer technologies in nails, plates and external fixators. Indian J Orthop, 2024, 59(3): 280-293.
36. Liu X, Miramini S, Patel M, et al. Balance between mechanical stability and mechano-biology of fracture healing under volar locking plate. Ann Biomed Eng, 2021, 49(9): 2533-2553.
37. 張英澤. 骨折順勢復位治療體系的建立. 北京: 人民衛生出版社, 2018: 574.
38. 張英澤, 韓志杰, 劉歡, 等. 河北醫科大學第三醫院骨折治療理念與原則. 河北醫科大學學報, 2017, 38(9): 1093-1095.
39. Wang L, You X, Lotinun S, et al. Mechanical sensing protein PIEZO1 regulates bone homeostasis via osteoblast-osteoclast crosstalk. Nat Commun, 2020, 11(1): 282. doi: 10.1038/s41467-019-14146-6.
40. Li X, Han L, Nookaew I, et al. Stimulation of Piezo1 by mechanical signals promotes bone anabolism. Elife, 2019, 8: e49631-e49653.

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