Objective To investigate the effectiveness of a new tibial plateau posterolateral column universal locking anatomical plate (hereinafter referred to as “new universal locking anatomical plate”) in the treatment of tibial plateau posterolateral column fractures. Methods Between October 2020 and December 2021, 14 patients with tibial plateau posterolateral column fracture were treated with a new universal locking anatomical plate. There were 7 males and 7 females with an average age of 59 years ranging from 29 to 75 years. There were 5 cases on the left side and 9 cases on the right side. The causes of injury included falling from height in 5 cases, traffic accident in 7 cases, and other injuries in 2 cases. The time from injury to operation ranged from 3 to 10 days, with an average of 6 days. According to Schatzker classification, there were 4 cases of type Ⅱ, 8 cases of type Ⅴ, and 2 cases of type Ⅵ. All fractures involved the posterolateral tibial plateau. Three column classification: two columns (anterolateral column+posterior column) in 4 cases, three columns in 10 cases. The operation time, intraoperative blood loss, fracture healing, and complications were recorded. The reduction of tibial plateau fracture was evaluated by Rasmussen radiographic score, and the recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score. Results All 14 cases completed the operation successfully. The operation time was 95-180 minutes, with an average of 154 minutes, and the intraoperative blood loss was 100-480 mL, with an average of 260 mL. All patients were followed up 6-19 months, with an average of 12.5 months. All fractures healed, and the healing time was 15-24 weeks, with an average of 18.7 weeks. During the follow-up, there was 1 case of common peroneal nerve palsy and 1 case of traumatic osteoarthritis. There was no other complication such as vascular injury, incision infection, deep venous thrombosis of lower limbs, heterotopic ossification, bone nonunion, and failure of internal fixation. The reduction of tibial plateau fractures was good immediately after operation, and the Rasmussen radiological score was 10-18, with an average of 15.7; 3 cases were excellent, 10 cases were good, and 1 case was fair, with an excellent and good rate of 92.9%. The scores and grades of HSS at 3 months after operation and at last follow-up significantly improved when compared with those before operation (P<0.05). There was no significant difference between 3 months after operation and last follow-up (P>0.05).Conclusion For the fractures involving the posterolateral column of the tibial plateau, the new universal locking anatomical plate can provide strong fixation, satisfactory postoperative fracture reduction, and good recovery of knee function.
Objective To observe the cl inical results of treatment of Schatzker V/VI tibial plateau fracture involved posteromedial condyle through combined posteromedial and anterolateral approach and fixed with two or three plates. Methods From April 2005 to April 2008, 18 cases of tibial plateau fracture involved posteromedial condyle were treated, including 14 males and 4 females with an average age of 38.5 years old (range, 18-62 years old). According to Schatzker classification, there were 12 cases of type V and 6 cases of type VI. The posteromedial condyle were involved in 13 cases and bilateral posterior condyle in 5 cases. All patients were given posteromedial fragment and medial condyle fracture reduction through posteromedial approach firstly, and then lateral condyle fracture reduction through anterolateral approach, and injury of meniscuses and cruciate l igaments were treated at the same time. Three plates (lateral, medial, posterior) were used in 10 cases and two plates (lateral, posteromedial) in 8 cases. Results All wounds achieved heal ing by first intention without compl ications such as infection, flap necrosis, osteofascial compartment syndrome, chronic osteomyel itis, nonunion. All patients were followed up for 12 to 48 months with an average of 24.4 months. The mean flexion of the knee was 118.4° (range, 100-130°) 1 year after operation. According to Iowa evaluation system, 12 patients got excellent results, 4 good, and 2 fair; the excellent and good rate was 88.9%. Conclusion Combined posteromedial and anterolateral approach and fixed with two or three plates is effective in treatment of the Schatzker V/VI tibial plateau fracture involved posteromedial condyle. Anatomical reduction and rigid internal fixation of the posteromedial fragment are critical to successful operation.
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.
Objective To evaluate short-term effectiveness of staged management for complex tibial plateau fracture with severe soft tissue injury. Methods A clinical data of 12 patients with complex tibial plateau fractures and severe soft tissue injuries between July 2017 and March 2021 and met the selection criteria was retrospectively analyzed. There were 7 males and 5 females with an average age of 43.1 years (range, 33-58 years). All patients were traffic accident injuries and admitted to hospital within 24 hours after injury. The tibial plateau fractures were closed fractures. According to the Schatzker classification standard, the fractures were rated as type Ⅳ in 3 cases, type Ⅴ in 4 cases, and type Ⅵ in 5 cases. According to the Tscherne classification standard, the soft tissue injuries were rated as grade Ⅱ in 4 cases and grade Ⅲ in 8 cases. The treatment of all patients was divided into 3 stages. In the first stage, emergency trans-articular fracture fixation with external fixator was performed; in the second stage, the fracture reduction and internal fixation were performed and bone cement was implanted to fill the bone defect; in the third stage, the bone cement was removed and the bone graft was performed to repair defect. All patients performed joint function exercise after operation as early as possible. Results There was no neurological symptom after all staged managements, the incisions healed by first intention, and no complications such as incision infection or necrosis occurred. All patients were followed up 6-32 months (mean, 16.9 months). The fractures were all anatomical reduction confirmed by the X-ray films after operation. During follow-up, there was no obvious loss of reduction, loosening and rupture of internal fixator, or collapse of the articular surface. All fractures healed after 14-20 weeks (mean, 17.6 weeks). The posterior slope angle of the tibial plateau was (9.7±2.3)° and the varus angle was (3.9±1.9)° immediately after bone grafting, and were (8.5±2.9)° and (4.3±1.9)° respectively at 6 months after operation. There was no significant difference between the two time points (t=0.658, P=0.514; t=−1.167, P=0.103). At last follow-up, the Hospital for Special Surgery (HSS) score was 85-96 (mean, 91.2), and the range of motion of knee was 110°-135° (mean, 120.9°). Conclusion The staged management for complex tibial plateau fracture with severe soft tissue injury can obtain good short-term effectiveness, but the long-term effectiveness needs to be further followed up.
Objective To compare the biomechanical differences among the three novel internal fixation modes in treatment of bicondylar four-quadrant fractures of the tibial plateau through finite-element technique, and find an internal fixation modes which was the most consistent with mechanical principles. Methods Based on the CT image data of the tibial plateau of a healthy male volunteer, a bicondylar four-quadrant fracture model of the tibial plateau and three experimental internal fixation modes were established by using finite element analysis software. The anterolateral tibial plateaus of groups A, B, and C were fixed with inverted L-shaped anatomic locking plates. In group A, the anteromedial and posteromedial plateaus were longitudinally fixed with reconstruction plates, and the posterolateral plateau was obliquely fixed with reconstruction plate. In groups B and C, the medial proximal tibia was fixed with T-shaped plate, and the posteromedial plateau was longitudinally fixed with the reconstruction plate or posterolateral plateau was obliquely fixed with the reconstruction plate, respectively. An axial load of 1 200 N was applied to the tibial plateau (a simulation of a 60 kg adult walking with physiological gait), and the maximum displacement of fracture and maximum Von-Mises stress of the tibia, implants, and fracture line were calculated in 3 groups. Results Finite element analysis showed that the stress concentration area of tibia in each group was distributed at the intersection between the fracture line and screw thread, and the stress concentration area of the implant was distributed at the joint of screws and the fracture fragments. When axial load of 1 200 N was applied, the maximum displacement of fracture fragments in the 3 groups was similar, and group A had the largest displacement (0.74 mm) and group B had the smallest displacement (0.65 mm). The maximum Von-Mises stress of implant in group C was the smallest (95.49 MPa), while that in group B was the largest (177.96 MPa). The maximum Von-Mises stress of tibia in group C was the smallest (43.35 MPa), and that in group B was the largest (120.50 MPa). The maximum Von-Mises stress of fracture line in group A was the smallest (42.60 MPa), and that in group B was the largest (120.50 MPa). Conclusion For the bicondylar four-quadrant fracture of the tibial plateau, a T-shaped plate fixed in medial tibial plateau has a stronger supporting effect than the use of two reconstruction plates fixed in the anteromedial and posteromedial plateaus, which should be served as the main plate. The reconstruction plate, which plays an auxiliary role, is easier to achieve anti-glide effect when it is longitudinally fixed in posteromedial plateau than obliquely fixed in posterolateral plateau, which contributes to the establishment of a more stable biomechanical structure.
Objective To summarize the effectiveness of 3.5 mm T support plate fixation for simple postero-lateral tibial plateau fractures by posterolateral inverted L-shaped approach. Methods Between March 2011 and January 2016, 13 patients with simple posterolateral tibial plateau fracture were treated with 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach. Of 13 cases, 6 were male and 7 were female, aged 28 to 52 years (mean, 43 years). The left side was involved in 5 cases and the right side in 8 cases. The causes of injury were traffic accidents in 6 cases, falls in 3 cases, and falling from height in 4 cases. All of patients had fresh closed fracture by X-ray, CT three dimensional reconstruction, and MRI. According to Schatzker classification, 4 cases were rated as type II and 9 cases as type III. The time between injury and operation was 5-9 days (mean, 7 days). Results One case had incision skin necrosis, which was cured after debridement and skin grafting; and primary healing was obtained in the other cases. The patients were followed up 10-16 months (mean, 13 months). The X-ray film showed that the fracture line was blurred at 3 months after operation, and disappeared at 12 months after operation. There was no complications of wound infection, major neurovascular injury, loosening or breakage of internal fixation, and dislocation of joint surface. The Hospital for Special Surgery (HSS) knee function score was 94 (range, 89-97) at last follow-up; all were excellent. Conclusion The 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach is one of preferred surgical method for the treatment of simple posterolateral tibial plateau fractures.
Objective To investigate the improved reduction technique for depression fractures of the lateral tibial plateau and its effectiveness. Methods Between January 2008 and December 2010, 48 patients (48 knees) with depression fractures of the lateral tibial plateau (Schatzker II or III fractures) were treated. There were 32 males and 16 females with an average age of 45.8 years (range, 16-79 years). All fractures were fresh closed fractures, which were caused by traffic accident in 27 cases, by falling from height in 5 cases, by crushing in 8 cases, and by sustained falls in 8 cases. According to Schatzker classification, 29 cases were classified as type II and 19 cases as type III. The lateral cortex was cut off to expose the depression and compacted cancellous bone was elevated to reset the articular surface. After reduction, autologous iliac bone graft and locking plate internal fixation were used. Results Healing of incision by first intention was achieved in all patients, and no complication occurred. All patients were followed up 1.7 years on average (range, 1-3 years). At last follow-up, the knee extension was ( — 0.5 ± 0.3)°, and the knee flexion was (136.9 ± 8.8)°. X-ray films showed that the fracture healing time was 52 weeks and no breakage of internal fixation occurred. According to Rasmussen clinical score, the results were excellent in 35 cases, good in 10 cases, and fair in 3 cases. According to Rasmussen radiographical score, the results were excellent in 41 cases, good in 7 cases; there were 41 excellent scores and 7 good scores of articular reduction; all gained good recovery of coronal and sagittal alignment and condylar width. The articular surface collapse was (1.0 ± 0.7) mm at immediate postoperatively and (1.2 ± 0.7) mm at last follow-up, showing no significant difference (t= — 1.42, P=0.20), but significant differences were found when compared with that at preoperation [(12.2 ± 8.0) mm, P lt; 0.05]. Conclusion This improved technique can provide a satisfactory effectiveness of fracture reduction and can avoid loss of reduction. The short-term effectiveness is good, but futher follow-up is necessary to determine the long-term results.
Objective To introduce a surgical protocol based on the location and orientation of the apex of the medial condylar fracture line for the treatment of Schatzker type Ⅳ tibial plateau fractures and report the preliminary effectiveness. Methods The clinical data of 18 patients with Schatzker type Ⅳ tibial plateau fractures underwent open reduction and internal fixation between March 2012 and April 2016 were retrospectively analysed. There were 6 males and 12 females, aged 36-74 years (mean, 45 years). The causes of injury included traffic accident in 2 cases, falling in 14 cases, bruise injury in 1 case, and crush injury of heavy object in 1 case. All cases were fresh closed fractures, without injury of nerves and blood vessels. According to sub type of Wahlquist tibial plateau type Ⅳ fracture classification, there were 1 case of type A, 5 cases of type B, and 12 cases of type C. The interval of injury and operation was 6-16 days (mean, 9.5 days). The location of the apex of the medial condylar fracture line was determined the surgical approach. After operation, reduction of tibial plateau fractures was evaluated by the DeCoster score evaluation criteria. The knee joint function was assessed by short Musculoskeletal Function Assessment (SMFA) score and Hospital for Special Surgery (HSS) score. Results The incisions all healed by first intension after operation without surgery related complications. All the patients obtained satisfactory exposure and reduction during operation. According to DeCoster score evaluation criteria, the results were excellent in 13 cases and fair in 5 cases. All the patients were followed up 12-30 months (mean, 18 months). X-ray films showed that all fractures healed at 10-16 weeks (mean, 12 weeks) after operation. There was no plate displacement, screw loosening, and other complications occurred during follow-up. At last follow-up, the SMFA score was 15-48 (mean, 28.5). The HSS score was 52-94 (mean, 81.1), and the results were excellent in 10 cases, good in 5 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 83.3%; the main clinical manifestation was severe traumatic osteoarthritis symptom in 1 case with the fair result. Conclusion The surgical program should be developed based on the location and orientation of the apex of the medial condylar fracture line. Open reduction and internal fixation for treating Schatzker type Ⅳ fractures can achieve satisfactory effectiveness.
Objective To compare the effectiveness and advantages of the double reverse traction reduction 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 operation 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 significantly superior outcomes in operation time, intraoperative 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 complication. 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 significant difference in follow-up duration between groups (P>0.05). Fractures healed in both groups with no significant difference in healing time (P>0.05). At 6 months after operation, Rasmussen radiological scores and grading showed no significant difference between the two groups (P>0.05); the double reverse traction group had significantly higher HSS scores compared to the traditional open group (P<0.05). At 12 months after operation, knee flexion/extension range of motion were significantly greater in the double reverse traction group than in the traditional open group (P<0.05). ConclusionDouble reverse traction reduction offers advantages over traditional open reduction, including shorter operation 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.
Objective To compare the effectiveness of arthroscopy assisted percutaneous internal fixation and open reduction and internal fixation for Schatzker types II and III tibial plateau fractures. Methods Between August 2006 and April 2010, 58 patients with tibial plateau fractures of Schatzker types II and III were treated with arthroscopy assisted percutaneous internal fixation (arthroscopy group, n=38), and with open reduction and internal fixation (control group, n=20). There was no significant difference in gender, age, disease duration, fracture type, and compl ication between 2 groups (P gt; 0.05). The operation time, incision length, fracture heal ing time, and compl ications were compared between 2 groups. Knee function score and the range of motion were measured according to American Hospital for Special Surgery (HSS) scorestandard. Results All patients achieved primary incision heal ing. The arthroscopy group had smaller incision length andlonger operation time than the control group, showing significant differences (P lt; 0.05). The patients of 2 groups were followed up 12 to 14 months. At 6 months, the HSS score and the range of motion of the arthroscopy group were significantly greater than those of the control group (P lt; 0.05). The X-ray films showed bony union in 2 groups. The fracture heal ing time of the arthroscopy group was shorter than that of the control group, but no significant difference was found (t=2.14, P=0.41). Morning stiffness occurred in 2 cases (5.3%) of the arthroscopy group, joint pain in 6 cases (30.0%) of the control group (3 cases had joint stiffness) at 1 week, which were cured after symptomatic treatment. There was significant difference in the incidence of compl ications between 2 groups (χ2=6.743, P=0.016). Conclusion The arthroscopy assisted percutaneous internal fixation is better than open reduction and internal fixation in the treatment of tibial plateau fractures of Schatzker types II and III, because it has smaller incision length and shorter fracture heal ing time.