Posterior popliteal fossa S-shaped incision with double-window approach in treating posterior column of tibial plateau fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAO Junna ¹ ,  WANG Honggang ² , QUAN Songtao ¹ , FENG Wei ¹ , CAI Litao ¹ , YANG MingLu ¹

1. Department Ⅱ of Knee Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China;
2. Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou Guangdong, 510080, P.R.China;

Corresponding author：

WANG Honggang, Email: docwhg@sina.com

Keywords：

Tibial plateau fracture; posterior column fracture; posterior approach

DOI：

10.7507/1002-1892.201906076

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Objective To evaluate the effectiveness and safty of posterior popliteal fossa S-shaped incision with double-window approach for the treatment of posterior column of tibial plateau fractures.Methods A retrospective analysis was made on the clinical data of 13 patients with complex tibial plateau fractures involving both posteromedial and posterolateral columns between May 2015 and July 2017. There were 9 males and 4 females, aged 33-64 years (mean, 46.5 years). The causes of injury included traffic accident in 5 cases, falling from height in 2 cases, falling from electric bicycle in 4 cases, and falling because of skiing in 2 cases. The preoperative range of motion of the affected knees was (35.1±9.2)°. The time from injury to surgery was 7-19 days (mean, 13.3 days). All patients underwent a posterior popliteal fossa S-shaped incision through the window of medial heads of gastrocnemius muscle (medial window) and the window between medial and lateral head of gastrocnemius muscle (popliteal fossa window) approaches. After a good visual control of fracture reduction, both posteromedial and posterolateral columns of tibial plateau fractures were fixed with buttress plate respectively. Bone union, limb alignment, articular surface, and range of motion were estimated after operation. The American Hospital for Special Surgery (HSS) score was used to evaluate functional outcomes of knees.Results After operation, 1 patient had fat liquefaction and dehiscence of incision, which healed after expanding the wound; the other patients’ incisions healed by first intention, and no vascular or nerve injury occurred during operation. All the 13 patients were followed up 12-18 months (mean, 16 months). The X-ray films showed that all patients obtained good fracture unions, the fracture healing time was 14-22 weeks (mean, 18 weeks). At 12 months after operation, the articular surface was smooth without collapse, and the knee range of motion was (109.5±13.6)°, showing significant difference when compared with preoperative value (t=18.879, P=0.000). No complication of infection, re-displacement of fracture, or secondary varus/valgus deformity was observed during follow-up. The HSS score was 82-96 (mean, 89.6) at 12 months after operation, with the result of excellent in 10 cases and good in 3 cases.Conclusion The posterior column fracture of tibial plateau involving both posteromedial and posterolateral columns treated by double-window approach through posterior popliteal fossa S-shaped incision is safe and effective, with satisfactory results and good recovery of knee joint function.

Citation： YAO Junna, WANG Honggang, QUAN Songtao, FENG Wei, CAI Litao, YANG MingLu. Posterior popliteal fossa S-shaped incision with double-window approach in treating posterior column of tibial plateau fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 574-578. doi: 10.7507/1002-1892.201906076 Copy

1.	Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11): 683-692.
2.	Chang SM, Hu SJ, Zhang YQ, et al. A surgical protocol for bicondylar four-quadrant tibial plateau fractures. Int Orthop, 2014, 38(12): 2559-2564.
3.	Yoon YC, Sim JA, Kim DH, et al. Combined lateral femoralepicondylar osteotomy and a submeniscal approach for thetreatment of a tibial plateau fracture involving the posterolateral quadrant. Injury, 2015, 46(2): 422-426.
4.	Chen HW, Luo CF. Extended anterolateral approach for treatmentof posterolateral tibial plateau fractures improves operative procedure and patient prognosis. Int J Clin Exp Med, 2015, 8(8): 13708-13715.
5.	Yu B, Han K, Zhan C, et al. Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee, 2010, 17(5): 313-318.
6.	Sun H, Zhai QL, Xu YF, et al. Combined approaches for fixation of Schatzker type Ⅱ tibial plateau fractures involving the posterolateral column: a prospective observational cohort study. Arch Orthop Trauma Surg, 2015, 135(2): 209-221.
7.	杨小海, 徐锋, 尹自飞, 等. 后外侧倒 L 形入路 3.5 mm T 形支撑钢板内固定治疗单纯后外侧胫骨平台骨折疗效观察. 中国修复重建外科杂志, 2017, 31(7): 815-819.
8.	Insall JN, Dorr LD, Scott RD, et al. Rationale of the knee society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
9.	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.
10.	Hoekstra H, Kempenaers K, Nijs S. A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures. Eur J Trauma Emerg Surg, 2017, 43(5): 637-643.
11.	Yang G, Zhai Q, Zhu Y, et al. The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system. Arch Orthop Trauma Surg, 2013, 133(7): 929-934.
12.	Kfuri M, Schatzker J, Castiglia MT, et al. Extended anterolateral approach for complex lateral tibial plateau fractures. J Knee Surg, 2017, 30(3): 204-211.
13.	Sun H, Luo CF, Yang G, et al. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol, 2013, 23(7): 809-818.
14.	Chen HW, Zhou SH, Liu GD, et al. An extended anterolateral approach for posterolateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc, 2015, 23(12): 3750-3755.
15.	Chen H, Chang S, Pan J. Recent progress in the diagnosis and treatment of posterior tibial plateau fractures. Int J Clin Exp Med, 2015, 8(4): 5640-5648.
16.	Garner MR, Warner SJ, Lorich DG. Surgical approaches to posterolateral tibial plateau fractures. J Knee Surg, 2016, 29(1): 12-20.
17.	陆圣君, 廖全明, 王克军. 前外侧入路排钉技术治疗单纯后外侧胫骨平台骨折疗效观察. 中国修复重建外科杂志, 2017, 31(3): 382-384.
18.	Brunner A, Honigmann P, Horisberger M, et al. Open reduction and fixation of medial Moore type Ⅱ fractures of the tibial plateau by a direct dorsal approach. Arch Orthop Trauma Surg, 2009, 129(9): 1233-1238.
19.	Connolly JF. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma, 2005, 19(7): 508.
20.	陈伟, 江汉, 王铜浩, 等. 半患侧卧位前后联合切口治疗复杂胫骨平台骨折. 中华骨科杂志, 2015, 35(7): 727-733.

1. Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11): 683-692.
2. Chang SM, Hu SJ, Zhang YQ, et al. A surgical protocol for bicondylar four-quadrant tibial plateau fractures. Int Orthop, 2014, 38(12): 2559-2564.
3. Yoon YC, Sim JA, Kim DH, et al. Combined lateral femoralepicondylar osteotomy and a submeniscal approach for thetreatment of a tibial plateau fracture involving the posterolateral quadrant. Injury, 2015, 46(2): 422-426.
4. Chen HW, Luo CF. Extended anterolateral approach for treatmentof posterolateral tibial plateau fractures improves operative procedure and patient prognosis. Int J Clin Exp Med, 2015, 8(8): 13708-13715.
5. Yu B, Han K, Zhan C, et al. Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee, 2010, 17(5): 313-318.
6. Sun H, Zhai QL, Xu YF, et al. Combined approaches for fixation of Schatzker type Ⅱ tibial plateau fractures involving the posterolateral column: a prospective observational cohort study. Arch Orthop Trauma Surg, 2015, 135(2): 209-221.
7. 杨小海, 徐锋, 尹自飞, 等. 后外侧倒 L 形入路 3.5 mm T 形支撑钢板内固定治疗单纯后外侧胫骨平台骨折疗效观察. 中国修复重建外科杂志, 2017, 31(7): 815-819.
8. Insall JN, Dorr LD, Scott RD, et al. Rationale of the knee society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
9. 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.
10. Hoekstra H, Kempenaers K, Nijs S. A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures. Eur J Trauma Emerg Surg, 2017, 43(5): 637-643.
11. Yang G, Zhai Q, Zhu Y, et al. The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system. Arch Orthop Trauma Surg, 2013, 133(7): 929-934.
12. Kfuri M, Schatzker J, Castiglia MT, et al. Extended anterolateral approach for complex lateral tibial plateau fractures. J Knee Surg, 2017, 30(3): 204-211.
13. Sun H, Luo CF, Yang G, et al. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol, 2013, 23(7): 809-818.
14. Chen HW, Zhou SH, Liu GD, et al. An extended anterolateral approach for posterolateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc, 2015, 23(12): 3750-3755.
15. Chen H, Chang S, Pan J. Recent progress in the diagnosis and treatment of posterior tibial plateau fractures. Int J Clin Exp Med, 2015, 8(4): 5640-5648.
16. Garner MR, Warner SJ, Lorich DG. Surgical approaches to posterolateral tibial plateau fractures. J Knee Surg, 2016, 29(1): 12-20.
17. 陆圣君, 廖全明, 王克军. 前外侧入路排钉技术治疗单纯后外侧胫骨平台骨折疗效观察. 中国修复重建外科杂志, 2017, 31(3): 382-384.
18. Brunner A, Honigmann P, Horisberger M, et al. Open reduction and fixation of medial Moore type Ⅱ fractures of the tibial plateau by a direct dorsal approach. Arch Orthop Trauma Surg, 2009, 129(9): 1233-1238.
19. Connolly JF. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma, 2005, 19(7): 508.
20. 陈伟, 江汉, 王铜浩, 等. 半患侧卧位前后联合切口治疗复杂胫骨平台骨折. 中华骨科杂志, 2015, 35(7): 727-733.

Chinese Journal of Reparative and Reconstructive Surgery

Posterior popliteal fossa S-shaped incision with double-window approach in treating posterior column of tibial plateau fractures

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