WANG Zhaodong 1,2 , DUAN Keyou 1,2 , LIU Yajun 1,2 , XU Chen 1,2 , ZHU Zhonglian 1,2 , GUAN Jianzhong 1,2
  • 1. Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical University, Bengbu Anhui, 233000, P. R. China;
  • 2. Key Laboratory of Anhui Province for Tissue Transplantation, Bengbu Anhui, 233000, P. R. China;
DUAN Keyou, Email: keyouduan1221@163.com
Tibial plateau fracture; intermediate screw assisted reduction and fixation technique; fracture reduction; internal fixation; complicated fracture
10.7507/1002-1892.202412051
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Objective To explore effectiveness of intermediate screw assisted reduction and fixation technique in the treatment of Schatzker type V and VI tibial plateau fractures. Methods  A clinical data of 22 patients with Schatzker type V and VI tibial plateau fractures, who were admitted between June 2022 and December 2023 and met the selection criteria, was retrospectively analyzed. During operation, the intermediate screw assisted reduction and fixation technique was used. There were 14 males and 8 females with an average age of 46.3 years (range, 17-65 years). The fractures were caused by traffic accident in13 cases, by falls in 5 cases, and by falls from height in 4 cases. According to Schatzker classification criteria, 9 cases were type V and 13 cases were type VI. The time from injury to operation was 5-12 days (mean, 7.9 days). The operation time, intraoperative fluoroscopy times, and length of hospital stay were recorded. The knee joint mobility and Hospital for Special Surgery (HSS) score were recorded at last follow-up. X-ray films were taken to review the fracture healing. Rasmussen anatomical score, tibial plateau varus angle (TPVA), and posterior tibial slope (PTS) were estimated before operation, at immediate after operation, and at last follow-up in order to evaluate the fracture reduction effect and postoperative outcome. Results  The operation time was 85-140 minutes (mean, 103.9 minutes). Intraoperative fluoroscopy was performed 7-15 times (mean, 10.1 times). All incisions healed by first intention after operation, and no complications such as nerve or blood vessel injury occurred. The length of hospital stay ranged from 8 to 17 days (mean, 12.4 days). All patients were followed up 10-22 months (mean, 14.8 months). At last follow-up, the range of motion of knee joint was 110°-140° (mean, 125°). HSS score was rated as excellent in 16 cases, good in 5 cases, and fair in 1 case, with an excellent and good rate of 95.5%. X-ray films reexamination showed that all fractures healed well with the healing time of 12-17 weeks (mean, 14.8 weeks). No internal fixation failure occurred. Rasmussen’s anatomical score, TPVA, and PTS at immediate after operation and at last follow-up were superior to those before operation (P<0.05). And there was no significant difference between immediately after operation and the last follow-up (P>0.05). Conclusion  The treatment of Schatzker type V and VI tibial plateau fractures with intermediate screw assisted reduction and fixation technique is reliable, which can reduce the difficulty of reduction and fixation, improve the efficiency of reduction and fixation, reduce the operation time, achieve satisfactory reduction and fixation effect and postoperative prognosis, and achieve good recovery of knee joint function.

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