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 observe the effectiveness of the superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau. Methods Between June 2010 and February 2012, 20 cases of posterolateral fracture of the tibial plateau were treated through superior fibular head approach, including 1 case of simple posterolateral fracture of the tibial plateau and 19 cases of posterolateral fracture of the tibial plateau with other fractures. There were 12 males and 8 females with an average age of 42.2 years (range, 28-58 years). All patients had closed fractures. Fracture was caused by traffic accident in 14 cases, by falling from height in 4 cases, and by twist injury in 2 cases. Associated injuries included lateral meniscus injury in 5 cases, medial meniscus injury in 2 cases, and anterior cruciate ligament injury in 1 case. The time from injury to admission ranged from 90 minutes to 32 hours (mean, 4.5 hours), and the time from admission to operation was 5-12 days (mean, 7.8 days). All cases underwent fracture reduction and fixation with Pilon plates through the superior fibular head approach, and associated fracture and meniscal injury were treated. Results All incisions healed by first intention, and no numbness or articular instability occurred. All patients were followed up 6-26 months (mean, 19.1 months). The average fracture healing time was 10.2 weeks (range, 8-12 weeks). During following-up, no related complication of fixation loosening or articular surface loss occurred. According to Rasmussen knee score criteria at last follow-up, the score was 18-30 (mean, 27.9); 16 cases were graded as excellent, 3 cases as good, and 1 case as fair, with an excellent and good rate of 95%. Conclusion The superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau is simple, safe, and effective, and can achieve a good surgical outcome.
目的:探讨辅助后内侧切口及抗滑钢板治疗复杂胫骨平台骨折的临床疗效。方法:对我院2006年4月至2008年12月的28例复杂胫骨平台骨折病患(男19例,女9例,平均年龄37岁)进行辅助后内侧切口及抗滑钢板的临床手术治疗。结果:术后随访,24例效果良好,4例出现不良反应,经修复后愈合。结论:术后关节功能及切口恢复良好,外侧支撑钢板+后内侧抗滑钢板的双切口双钢板的手术方法是治疗复杂胫骨平台骨折安全、有效的方法,故在临床上有推广价值,但有待大规模病例来验证。
ObjectiveTo evaluate the effectiveness of reduction osteotomy for correction of varus knee during total knee arthroplasty. MethodsA retrospective analysis was made on the clinical data of 16 patients (24 knees) who received reduction osteotomy for correcting varus knee during total knee arthroplasty between May 2010 and July 2012. There were 2 males (3 knees) and 14 females (21 knees), with an average age of 67 years (range, 57-79 years). The disease duration ranged from 3 to 15 years (mean, 9.1 years). The Knee Society Score (KSS) was 38.71±10.04 for clinical score and 50.31±14.31 for functional score. The range of motion (ROM) of the knee was (91.88±13.01)°. The tibiofemoral angle was (9.04±4.53)° of varus deformity. Reduction osteotomy was applied to correct varus knee. ResultsThe operation time was 85-245 minutes (mean, 165.5 minutes); the obvious blood loss was 10-800 mL (mean, 183.1 mL); the hospitalization time was 8-22 days (mean, 13.6 days). All incisions healed by first intention. No neurovascular injury or patellar fracture occurred. The follow-up duration ranged from 37 to 62 months (mean, 48 months). The tibiofemoral angle was corrected to (3.92±1.89)° of valgus at 48 hours after operation. The lower limb alignment recovered to normal. The X-ray films showed no evidence of obvious radiolucent line, osteolysis, or prosthesis subsidence. The results of KSS were significantly improved to 84.21±6.49 for clinical score and 85.31±6.95 for functional score (t=20.665, P=0.000; t=9.585, P=0.000); and ROM of the knee was significantly increased to (105.83±11.29)° (t=8.333, P=0.000) at last follow-up. ConclusionThe effectiveness of reduction osteotomy for varus knee deformity during total knee arthroplasty is satisfactory. Proper alignment, ROM, and function of knee can be achieved.
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 the effectiveness and safety of minimally invasive treatment for bilateral tibial plateau fractures using the double reverse traction reducer. Methods The 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 total mean operation time was 80.25 minutes (range, 73-86 minutes), with a mean total 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 complication, such as deep vein thrombosis, joint stiffness, post-traumatic arthritis, or implant failure, was 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.
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 the biomechanics of a novel injectable calcium phosphate cement (CPC) composited by poly (lactic-co-glycolic acid) (PLGA) combined with double-screw fixation in repairing Schatzker II type tibial plateau fracture, so as to provide the mechanical basis for the clinical minimally invasive treatment. Methods Ten matched pairs of proximal tibia specimens were harvested from 10 elderly cadavers to prepare Schatzker II type tibial plateau fracture model. Fracture was fixed by forcing injection of CPC (experimental group) or autologous cancellous bone (control group) combined with double-screw fixation. The samples underwent axial compression on MTS 858 material testing machine to measure the load-displacement, the maximum load, and compressive stiffness. Results The novel CPC had good injectable property at room temperature, which could fill in bone defect fully and permeated into the surrounding cancellous bone. The average bone mineral density of tibial metaphysis was (0.639 ± 0.081) g/cm2 in the experimental group and (0.668 ± 0.083) g/ cm2 in the control group, showing no significant difference (t=1.012, P=0.331). The maximum load in the experimental group [(4 101 ± 813) N] was significantly higher than that in the control group [(692 ± 138) N] (t=3.932, P=0.001). The compressive stiffness was (1 363 ± 362) N/mm in the experimental group and was (223 ± 54) N/mm in the control group, showing significant difference (t=3.023, P=0.013). Conclusion The novel CPC can effectively restore the biomechanical properties of tibilal plateau in repairing Schatzker II type tibial plateau fracture by means of forcing injection combining with double-screw fixation. It could be used as an effective bone substitute in the clinical application.