Effectiveness analysis of Zhang’s double reverse traction reducer in minimally invasive treatment of bilateral tibial plateau fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENG Zhanle , FAN Baoheng , WANG Zhongzheng , REN Rongqing , WANG Yiyang , WEI Ning ,  ZHANG Yingze

Trauma Emergency Center of the Third Hospital of Hebei Medical University, Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang Hebei, 050051, P. R. China;

Corresponding author：

ZHANG Yingze, Email: 38200671@hebmu.edu.cn

Keywords：

Bilateral lower limbs; tibial plateau fracture; double reverse traction reducer; minimally invasive treatment; knee function

DOI：

10.7507/1002-1892.202505053

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effectiveness and safety of minimally invasive treatment for bilateral tibial plateau fractures using the double reverse traction reducer. Methods Clinical data of 4 patients with bilateral tibial plateau fractures who met the selection criteria and treated between January 2016 and April 2024 were retrospectively analyzed. The cohort included 3 males and 1 female, aged 30-65 years (mean, 52.5 years). Injury mechanisms comprised traffic accidents (2 cases) and falls (2 cases). According to the Schatzker classification, 2 limbs were type Ⅱ and 6 were type Ⅵ. The time from injury to surgery ranged from 5 to 9 days (mean, 7 days). All patients underwent minimally invasive reduction using the double reverse traction reducer. Surgical duration, intraoperative blood loss, and hospitalization time were recorded. Functional outcomes were assessed at last follow-up using the Hospital for Special Surgery (HSS) knee score and range of motion (ROM), while fracture reduction quality was evaluated using the Rasmussen radiological score. Results All 4 patients successfully completed the procedure without conversion to open reduction. The mean operation time was 80.25 minutes (range, 73-86 minutes), with a mean intraoperative blood loss of 132.5 mL (range, 100-150 mL). The mean hospitalization time was 13.5 days (range, 11-16 days). All incisions healed primarily without neurovascular complications. X-ray film at 1 day after operation confirmed satisfactory reduction and articular surface alignment. Follow-up time ranged from 12 to 26 months (mean, 17.0 months). Fractures achieved clinical union at an average of 13 weeks (range, 12-16 weeks). No complications, such as deep vein thrombosis, joint stiffness, post-traumatic arthritis, or implant failure, were observed. At last follow-up, the mean HSS score was 92.9 (range, 90-97), mean knee ROM was 128.1° (range, 115°-135°), and mean Rasmussen radiological score was 16.4 (range, 15-19), with 2 limbs rated as excellent and 6 as good. Conclusion The double reverse traction reducer facilitates minimally invasive treatment of bilateral tibial plateau fractures with advantages including minimal trauma, shorter surgical duration, precise reduction, and fewer complications, effectively promoting fracture healing and functional recovery of the knee joint.

1.	Zhang Yingze. Clinical epidemiology of orthopaedic trauma. 2nd Edition. Thieme, Stuttgart: New York Delhi Rio de Janeiro, 2016: 125.
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.	Bae KC, Cho CH, Lee KJ, et al. Bilateral medial tibial plateau fracture after arthroscopic anterior cruciate ligament reconstruction. Knee Surg Relat Res, 2015, 27(2): 129-132.
4.	Carroll JJ, Kelly SP, Foster JN, et al. Bilateral proximal tibia stress fractures through persistent physes. Case Rep Orthop, 2018, 2018: 8181547. doi: 10.1155/2018/8181547.
5.	Şanel S, Demiröz S, Coskun T. Low-energy trauma-induced bilateral isolated posteromedial tibial plateau fracture in a healthy young adult: A case report. J Orthop Case Rep, 2023, 13(12): 63-66.
6.	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.
7.	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.
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.	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.
12.	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.
13.	Crabtree RM, Bergin PF, Graves ML, et al. Bicondylar tibial plateau fracture dislocations with an intact anterolateral cortical rim: A surgical technique. Injury, 2023, 54(3): 1004-1010.
14.	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.
15.	张英泽. 胫骨平台骨折微创治疗策略与进展. 中华创伤骨科杂志, 2017, 19(10): 829-832.
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.	史泰龙, 丁凯, 宇文培之, 等. 双反牵引闭合复位经皮内固定与切开复位内固定治疗胫骨平台骨折术后炎症指标和效果的比较. 中华创伤骨科杂志, 2025, 27(2): 125-132.
18.	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.
19.	魏子健, 覃健, 陈思春, 等. 关节镜联合微创经皮钢板内固定治疗低能量胫骨平台骨折伴韧带损伤患者的临床效果分析. 中外医学研究, 2022, 20(28): 14-18.
20.	张元涛. 关节镜与微创经皮钢板内固定联合治疗低能量胫骨平台骨折合并韧带损伤的效果观察. 世界复合医学, 2022, 8(7): 46-49.
21.	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.
22.	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.
23.	陈阳, 刘忠玉, 赵俊超, 等. 关节镜辅助复位内固定治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折. 中华骨科杂志, 2022, 42(10): 644-651.
24.	Kiefer H, Zivaljevic N, Imbriglia JE. Arthroscopic reduction and internal fixation (ARIF) of lateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc, 2001, 9(3): 167-172.

1. Zhang Yingze. Clinical epidemiology of orthopaedic trauma. 2nd Edition. Thieme, Stuttgart: New York Delhi Rio de Janeiro, 2016: 125.
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. Bae KC, Cho CH, Lee KJ, et al. Bilateral medial tibial plateau fracture after arthroscopic anterior cruciate ligament reconstruction. Knee Surg Relat Res, 2015, 27(2): 129-132.
4. Carroll JJ, Kelly SP, Foster JN, et al. Bilateral proximal tibia stress fractures through persistent physes. Case Rep Orthop, 2018, 2018: 8181547. doi: 10.1155/2018/8181547.
5. Şanel S, Demiröz S, Coskun T. Low-energy trauma-induced bilateral isolated posteromedial tibial plateau fracture in a healthy young adult: A case report. J Orthop Case Rep, 2023, 13(12): 63-66.
6. 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.
7. 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.
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. 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.
12. 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.
13. Crabtree RM, Bergin PF, Graves ML, et al. Bicondylar tibial plateau fracture dislocations with an intact anterolateral cortical rim: A surgical technique. Injury, 2023, 54(3): 1004-1010.
14. 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.
15. 张英泽. 胫骨平台骨折微创治疗策略与进展. 中华创伤骨科杂志, 2017, 19(10): 829-832.
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. 史泰龙, 丁凯, 宇文培之, 等. 双反牵引闭合复位经皮内固定与切开复位内固定治疗胫骨平台骨折术后炎症指标和效果的比较. 中华创伤骨科杂志, 2025, 27(2): 125-132.
18. 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.
19. 魏子健, 覃健, 陈思春, 等. 关节镜联合微创经皮钢板内固定治疗低能量胫骨平台骨折伴韧带损伤患者的临床效果分析. 中外医学研究, 2022, 20(28): 14-18.
20. 张元涛. 关节镜与微创经皮钢板内固定联合治疗低能量胫骨平台骨折合并韧带损伤的效果观察. 世界复合医学, 2022, 8(7): 46-49.
21. 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.
22. 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.
23. 陈阳, 刘忠玉, 赵俊超, 等. 关节镜辅助复位内固定治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折. 中华骨科杂志, 2022, 42(10): 644-651.
24. Kiefer H, Zivaljevic N, Imbriglia JE. Arthroscopic reduction and internal fixation (ARIF) of lateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc, 2001, 9(3): 167-172.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesEffectiveness analysis of Zhang’s double reverse traction reducer in minimally invasive treatment of bilateral tibial plateau fractures

Abstract Full text Figures/Tables Video References Cited by

Format

Content