Comparative study on effectiveness of double reverse traction reduction versus open reduction internal fixation in treating complex tibial plateau fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Hao , LIN Zhihao , MA Yueyan , GONG Haifeng , WANG Tianrui , YE Fagang ,  HU Yangling

Department of Trauma Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266035, P. R. China;

Corresponding author：

HU Yangling, Email: huyanlingqy@126.com

Keywords：

Tibial plateau fracture; complex fracture; traction reduction; closed reduction; internal fixation; minimally invasive surgery

DOI：

10.7507/1002-1892.202504101

Video：

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Objective To compare the effectiveness and advantages of the double reverse traction reduction technique versus open reduction internal fixation for treating complex tibial plateau fractures. Methods A clinical data of 25 patients with Schatzker type Ⅴ or Ⅵ tibial plateau fractures, who met the selection criteria and were admitted between January 2019 and January 2023, was retrospectively analyzed. Thirteen patients underwent double reverse traction reduction and internal fixation (double reverse traction group), while 12 patients underwent open reduction and internal fixation (traditional open group). There was no significant difference in the baseline data (age, gender, injury mechanism, Schatzker classification, interval between injury and operation) between the two groups (P>0.05). The effectiveness were evaluated and compared between the two groups, included operative time, intraoperative blood loss, incision length, hospital stay, full weight-bearing time, complications, fracture healing, Rasmussen radiological score (reduction quality), knee Hospital for Special Surgery (HSS) score, and knee flexion/extension range of motion. Results The double reverse traction group demonstrated superior outcomes in operative time, blood loss, hospital stay, incision length, and time to full weight-bearing (P<0.05). Two patients in traditional open group developed incisional complications, while the double reverse traction group had no complications. There was no significant difference in the incidence of complication between the two groups (P>0.05). All patients were followed up 24-36 months (mean, 30 months), with no intergroup difference in follow-up duration (P>0.05). Fractures healed in both groups with no significant difference in healing times (P>0.05). At 6 months after operation, Rasmussen radiological scores and grading showed no significant difference (P>0.05); the double reverse traction group had significantly higher HSS scores and grading compared to the traditional open group (P<0.05). At 12 months after operation, knee flexion/extension range of motion were significantly greater in double reverse traction group than in traditional open group (P<0.05). Conclusion Double reverse traction reduction offers advantages over traditional open reduction internal fixation, including shorter operative time, reduced blood loss, minimized soft tissue trauma, and improved joint functional recovery. It is a safe and reliable method for complex tibial plateau fractures.

1.	Liu CD, Hu SJ, Chang SM, et al. Treatment of posterolateral tibial plateau fractures: a narrative review and therapeutic strategy. Int J Surg, 2025, 111(1): 1071-1082.
2.	Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res, 1979, (138): 94-104.
3.	Rohra N, Suri HS, Gangrade K. Functional and radiological outcome of Schatzker type Ⅴ and Ⅵ tibial plateau fracture treatment with dual plates with minimum 3 years follow-up: A prospective study. J Clin Diagn Res, 2016, 10(5): RC05-10.
4.	Chapman JP, Patrick MR, Reb CW, et al. Comparable outcomes with intramedullary nail and plate constructs for Schatzker Ⅵ tibial plateau fractures. Eur J Orthop Surg Traumatol, 2023, 33(5): 1653-1661.
5.	Gavaskar AS, Gopalan H, Tummala NC, et al. The extended posterolateral approach for split depression lateral tibial plateau fractures extending into the posterior column: 2 years follow up results of a prospective study. Injury, 2016, 47(7): 1497-1500.
6.	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.
7.	苏喧. 张英泽: 双反牵引微创复位固定治疗胫骨平台骨折. 中国医药科学, 2016, 6(5): 1-3.
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.	Deng X, Hu H, Wang Y, et al. Arthroscopically assisted evaluation of frequency and patterns of meniscal tears in operative tibial plateau fractures: a retrospective study. J Orthop Surg Res, 2021, 16(1): 117. doi: 10.1186/s13018-021-02265-0.
10.	Cao F, Xue H, Yan C, et al. Clinical application study of minimally invasive double-reverse traction in complex tibial plateau fractures. Biomed Res Int, 2022, 2022: 5564604. doi: 10.1155/2022/5564604.
11.	Smith TO, Casey L, McNamara IR, et al. Surgical fixation methods for tibial plateau fractures. Cochrane Database Syst Rev, 2024, 8(8): CD009679. doi: 10.1002/14651858.CD009679.pub3.
12.	Coelho A, Parés-Alfonso I, Companys R, et al. Risk factors for infection of tibial plateau fractures. Rev Esp Cir Ortop Traumatol, 2024, 68(1): 44-49.
13.	Kim CW, Lee CR, An KC, et al. Predictors of reduction loss in tibial plateau fracture surgery: Focusing on posterior coronal fractures. Injury, 2016, 47(7): 1483-1487.
14.	姜新峰, 陈华. 股骨撑开器辅助复位治疗不稳定型胫骨平台骨折疗效分析. 江苏医药, 2016, 42(13): 1511-1512.
15.	张英泽. 顺势复位固定微创治疗胫骨平台骨折. 中华骨科杂志, 2023, 43(22): 1473-1476.
16.	扈延龄, 徐凤磊, 李春燕, 等. 双反牵引复位微创经皮接骨板内固定术治疗胫骨中远段粉碎性骨折. 中国矫形外科杂志, 2018, 26(12): 1140-1142.
17.	王博, 郑占乐, 刘欢, 等. 张氏加压骨栓治疗胫骨平台骨折的初步临床应用. 河北医科大学学报, 2018, 39(7): 851-852.
18.	郑占乐, 连晓东, 王博, 等. 经胫前隧道推顶复位胫骨平台塌陷骨折. 中华创伤骨科杂志, 2020, 22(8): 693-697.
19.	陈阳, 刘忠玉, 赵俊超, 等. 关节镜辅助复位内固定治疗Schatzker Ⅰ~Ⅲ型胫骨平台骨折. 中华骨科杂志, 2022, 42(10): 644-651.
20.	Kiefer H, Zivaljevic N, Imbriglia J E. Arthroscopic reduction and internal fixation (ARIF) of lateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc, 2001, 9(3): 167-172.
21.	邓翔天, 郑占乐, 邵德成, 等. 关节镜下评估胫骨平台骨折合并半月板撕裂和交叉韧带损伤的临床研究. 中华外科杂志, 2021, 59(6): 464-469.
22.	王东, 邓翔天, 赵仁良, 等. 双反牵引辅助复位与切开复位内固定治疗胫骨平台骨折的疗效比较. 中华骨科杂志, 2023, 43(22): 1477-1484.

1. Liu CD, Hu SJ, Chang SM, et al. Treatment of posterolateral tibial plateau fractures: a narrative review and therapeutic strategy. Int J Surg, 2025, 111(1): 1071-1082.
2. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res, 1979, (138): 94-104.
3. Rohra N, Suri HS, Gangrade K. Functional and radiological outcome of Schatzker type Ⅴ and Ⅵ tibial plateau fracture treatment with dual plates with minimum 3 years follow-up: A prospective study. J Clin Diagn Res, 2016, 10(5): RC05-10.
4. Chapman JP, Patrick MR, Reb CW, et al. Comparable outcomes with intramedullary nail and plate constructs for Schatzker Ⅵ tibial plateau fractures. Eur J Orthop Surg Traumatol, 2023, 33(5): 1653-1661.
5. Gavaskar AS, Gopalan H, Tummala NC, et al. The extended posterolateral approach for split depression lateral tibial plateau fractures extending into the posterior column: 2 years follow up results of a prospective study. Injury, 2016, 47(7): 1497-1500.
6. 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.
7. 苏喧. 张英泽: 双反牵引微创复位固定治疗胫骨平台骨折. 中国医药科学, 2016, 6(5): 1-3.
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. Deng X, Hu H, Wang Y, et al. Arthroscopically assisted evaluation of frequency and patterns of meniscal tears in operative tibial plateau fractures: a retrospective study. J Orthop Surg Res, 2021, 16(1): 117. doi: 10.1186/s13018-021-02265-0.
10. Cao F, Xue H, Yan C, et al. Clinical application study of minimally invasive double-reverse traction in complex tibial plateau fractures. Biomed Res Int, 2022, 2022: 5564604. doi: 10.1155/2022/5564604.
11. Smith TO, Casey L, McNamara IR, et al. Surgical fixation methods for tibial plateau fractures. Cochrane Database Syst Rev, 2024, 8(8): CD009679. doi: 10.1002/14651858.CD009679.pub3.
12. Coelho A, Parés-Alfonso I, Companys R, et al. Risk factors for infection of tibial plateau fractures. Rev Esp Cir Ortop Traumatol, 2024, 68(1): 44-49.
13. Kim CW, Lee CR, An KC, et al. Predictors of reduction loss in tibial plateau fracture surgery: Focusing on posterior coronal fractures. Injury, 2016, 47(7): 1483-1487.
14. 姜新峰, 陈华. 股骨撑开器辅助复位治疗不稳定型胫骨平台骨折疗效分析. 江苏医药, 2016, 42(13): 1511-1512.
15. 张英泽. 顺势复位固定微创治疗胫骨平台骨折. 中华骨科杂志, 2023, 43(22): 1473-1476.
16. 扈延龄, 徐凤磊, 李春燕, 等. 双反牵引复位微创经皮接骨板内固定术治疗胫骨中远段粉碎性骨折. 中国矫形外科杂志, 2018, 26(12): 1140-1142.
17. 王博, 郑占乐, 刘欢, 等. 张氏加压骨栓治疗胫骨平台骨折的初步临床应用. 河北医科大学学报, 2018, 39(7): 851-852.
18. 郑占乐, 连晓东, 王博, 等. 经胫前隧道推顶复位胫骨平台塌陷骨折. 中华创伤骨科杂志, 2020, 22(8): 693-697.
19. 陈阳, 刘忠玉, 赵俊超, 等. 关节镜辅助复位内固定治疗Schatzker Ⅰ~Ⅲ型胫骨平台骨折. 中华骨科杂志, 2022, 42(10): 644-651.
20. Kiefer H, Zivaljevic N, Imbriglia J E. Arthroscopic reduction and internal fixation (ARIF) of lateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc, 2001, 9(3): 167-172.
21. 邓翔天, 郑占乐, 邵德成, 等. 关节镜下评估胫骨平台骨折合并半月板撕裂和交叉韧带损伤的临床研究. 中华外科杂志, 2021, 59(6): 464-469.
22. 王东, 邓翔天, 赵仁良, 等. 双反牵引辅助复位与切开复位内固定治疗胫骨平台骨折的疗效比较. 中华骨科杂志, 2023, 43(22): 1477-1484.

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