Abstract

BackgroundThe clinical effect of the three-incision combined approach for complex fracture of tibial plateau involving the posterior tibial plateau was discussed.MethodsA retrospective analysis was performed for 13 cases receiving surgery for complex fracture of tibial plateau from July 2015 to June 2019. They received surgery via the three-incision combined approach, and regular postoperative reexamination was performed at the outpatient clinic. During the last follow-up, Hospital for Special Surgery (HSS) Knee Scoring System was used to assess the knee joint function; the Lysholm score was used to assess the knee mobility. The anterior, posterior, and rotational stabilities of the knee joint were assessed by the Lachman test and pivot-shift test.ResultsThere was no nonunion and delayed union, implant loosening and fracture, or refracture, and neither were there neurological symptoms or restricted mobility in daily life. During the follow-up, none of the cases were found with restriction of knee mobility caused by internal fixation or apparent pain. The HSS score during the last follow-up was 86–100 (average, 90.2 ± 6.8), and the excellent and good rate was 100%; the Lysholm score was 86–100 (average, 95.7 ± 2.6). All cases were negative for the Lachman test and pivot-shift test. The knee flexion mobility was 100~140° (average, 127.2° ± 11.4°). Postoperative X-ray indicated anatomical reduction of bone fractures in all cases. Loss of reduction or loosening and fracture of internal fixation was not observed by postoperative regular reexaminations. The posterior tibial slope at 6 months after surgery was 6~16° (average, 10.66 ± 2.58°), the varus angle was 84~89° (average, 86.52 ± 1.46°), the Rasmussen radiological score was 12~18 (average, 16.12 ± 1.35), and the excellent and good rate was 100%.ConclusionThe three-incision combined approach proved safe and reliable for complex fracture of tibial plateau involving the posterior tibial plateau and is worthy of further popularization.

Highlights

  • The clinical effect of the three-incision combined approach for complex fracture of tibial plateau involving the posterior tibial plateau was discussed

  • We innovatively proposed a three-incision combined approach to treat this type of tibial plateau fracture, and a retrospective analysis was conducted for the following purposes: (1) to determine the indications for the threeincision combined approach, (2) to assess the feasibility and short-term efficacy of the three-incision combined approach for the complex tibial plateau fracture involving the posterior column, and (3) to summarize the advantages and defects of the three-incision combined approach

  • Inclusion and exclusion criteria The inclusion criteria were as follows: (1) adults with fresh tibial plateau fracture; (2) confirmed as type V tibial plateau fracture involving the posterior tibial plateau according to the Schatzker classification system by preoperative X-ray and Computed tomography (CT); (3) no apparent vascular and nerve damage before surgery; (4) no preoperative incision infection or destructive injury, with soft tissue conditions allowing for internal fixation; (5) no apparent preoperative surgical contraindications and tolerable to surgery; and (6) postoperative follow-up ≥ 6 months

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Summary

Introduction

The clinical effect of the three-incision combined approach for complex fracture of tibial plateau involving the posterior tibial plateau was discussed. Classification of bone fractures is an important guiding principle for the treatment of complex tibial plateau fracture. For posterior column tibial plateau fracture, the conventional surgical approaches include Carlson’s approach and inverted L-shaped approach. Many scholars have attempted to modify the surgical approaches for this type of bone fractures, for example, modifying the anterolateral approach [8] and fibular osteotomy approach [9]. These approaches are mainly used to treat fractures involving the lateral and posterolateral tibial plateau. For fractures simultaneously involving the medial tibial plateau or having larger posterior fracture blocks that involve the posteromedial side, these approaches can hardly achieve effective reduction and fixation while reducing the invasiveness

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