Objective To explore the effectiveness of limited incision, poking reduction, and simple internal fixation in the treatment of collapsed fractures of the posterolateral tibial plateau. Methods Between October 2010 and January 2016, 16 patients with collapsed fractures of the posterolateral tibial plateau underwent posterolateral incision, poking reduction, and simple internal fixation. There were 10 males and 6 females with the age of 22-63 years (mean, 43.5 years). The injury was caused by falling in 5 cases, traffic accident in 7 cases, and falling from height in 4 cases. All cases had closed fractures. The left knee was involved in 9 cases and the right knee in 7 cases. The injury-to-admission time was 2 hours to 3 days (mean, 10 hours). X-ray films showed that the articular surface collapsing was more than 2 mm. According to Schatzker criteria, 6 cases were rated as type II and 10 cases as type III. Twelve cases had fracture of fibular head. The incision length, operation time, intraoperative blood loss, and incision healing were recorded; fracture healing was observed, and tibial plateau angle and posterior slope angle were measured on X-ray films; loss of articular surface reduction was observed by CT scan; and American Hospital for Special Surgery (HSS) score was used to evaluate the knee joint function. Results The incision length was 7-10 cm (mean, 8.6 cm); operation time was 35-55 minutes (mean, 46 minutes); intraoperative blood loss was 10-35 mL (mean, 28 mL). Primary healing of incision was obtained. Skin pain occurred in 1 case at 2 months because Kirschner wire retracted. Fifteen cases were followed up 8-21 months (mean, 13.5 months). The fracture healing time was from 3 to 6 months (mean, 4.8 months). There was no significant difference in tibial plateau angle and posterior slope angle between at immediate after operation and at last follow-up (t=–1.500, P=0.156; t=–1.781, P=0.097). The anatomic reduction rate of articular surface was 93.8% (15/16) at immediate after operation. At last follow-up, the recollapse height of articular surface was 0.1-1.2 mm (mean, 0.36 mm). According to the HSS score system, the results were excellent in 12 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 93.3%. Conclusion The limited incision by posterolateral approach, poking reduction, and simple internal fixation have the advantages of small injury, full exposure, and easy operation in the treatment of simple posterolateral tibial plateau fractures; bone graft support and simple internal fixation can prevent recollapse of the articular surface and achieve satisfactory knee function.
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.
Objective To investigate short-term effectiveness of robot-assisted fracture reduction and fixation combined with arthroscopic exploration for posterolateral depressed tibial plateau fractures. Methods Between January 2022 and January 2024, 8 patients with posterolateral depressed tibial plateau fractures (Schatzker type Ⅲ) were treated using robot-assisted fracture reduction and fixation combined with arthroscopic exploration, with simultaneous treatment of concomitant ligament or meniscus tears. There were 3 males and 5 females with an average age of 54.1 years (range, 42-68 years). Injury mechanisms included traffic accidents (3 cases) and falls (5 cases). The time from injury to operation ranged from 2 to 4 days (mean, 3.1 days). Operative time, intraoperative blood loss, hospital stay, visual analogue scale (VAS) score for pain, and complications were recorded. Fracture healing and knee Rasmussen scores were assessed radiographically, while knee function was evaluated using range of motion and Hospital for Special Surgery (HSS) scores. Results All operations were successfully completed. The operative time was 108-129 minutes (mean, 120.1 minutes). The intraoperative blood loss was 10-100 mL (mean, 41.3 mL). The hospital stay duration was 4-7 days (mean, 5.6 days). All incisions healed by first intention without complications such as peroneal nerve injury, vascular damage, or infection. All patients were followed up 32-48 weeks (mean, 40.0 weeks). Radiographic follow-up confirmed that the knee Rasmussen scores rated as excellent in 8 patients and all fractures healed with the healing time of 12-16 weeks (mean, 13.5 weeks). The VAS score for pain was 2-4 (mean, 2.8) at discharge and improved to 0 at 1 month. The knee range of motion was 80°-110° (mean, 96.1°) at discharge and increased to 135°-140°(mean, 137.9°) at 1 month after operation. At 3 months after operation, the HSS score was 91-94 (mean, 92.8), all graded as excellent. No severe complications, including implant failure, occurred during follow-up. Conclusion For posterolateral depressed tibial plateau fractures, the minimally invasive approach combining robot-assisted fracture reduction and fixation with arthroscopic exploration demonstrates multiple advantages, including shorter operative time, reduced intraoperative blood loss, excellent wound healing, fewer complications, and rapid recovery of knee function. This technique achieves satisfactory short-term effectiveness, while its long-term effectiveness requires further evaluation.