Combined approaches with a semilateral position for complex tibial plateau fracture

Abstract

Objective To explore the operation indication feasibility, operation technique and clinical effect of complex tibial plateau fractures with semilateral position through combined approaches. Methods From April 2011 to June 2013, data of 25 patients with complex tibial plateau fractures who were treated by open reduction and interal fixation with semilateral position through anterior lateral incision and an inverse L shaped incision were retrospectively analyzed. There were 15 males and 10 females, with an average age of 49.7 years old (range, 30 to 70 years old). 21 cases were traffic accident injuris and 4 cases were hurt by falling injuries from bicycle. All of the fracture patterns were three pillars of closed fracture of type Ⅵ according to Schatzker classification. The time at surgery was 5-21 days (mean, 9.5 days) after injuries. The posterior condylar and medial condylar fractures were dealt with inverse L shaped incision, and fixated with anatomical locking plate and T shaped plate. The lateral condyle fractures were dealt with anterior lateral incision, and fixated with anatomical locking plate. Results Operating time was 150-250 min with an average time of 197.6 min. Intraoperative blood loss was 150-300 ml with an average of 232 ml. 25 patients were followed-up, and the average duration of followup was 17.8 months (range, 12-24 months). Fracture healing time was 16-24 weeks with an average of 19 weeks. At the time of the latest followup, X-ray showed all the knee joint had smooth surface, and there was no obvious varus or valgus deformity. One year later, the flexion of the knees achieved 115.2° (range, 100°-130°), and the straighten reached 0°. The mean Rasmussen's score of all the patients were 14-18 (average, 16.6), and there were excellent in 11 cases and good in 14. Bassed on the KSS score, the mean score was 88.6 (range, 66-96) one year after operation. The excellent and good rate was 96% (24/25). 2 patients had fat liquefaction of anterolateral incision wound dehiscence, local skin necrosis, and they got good outcomes after debridement dressing and secondary suture. Conclusion Multi plate fixation is more effective and safty treatment for complex tibial plateau fractures which can be operated completely through fixed half lateral position, and the knee joint is allowed to do early functional exercise, achieving good clinical efficacy and good knee function. Key words: Tibial fractures; Fracture fixation, internal; Treatment outcome