Dual locking plate fixation for Type C3 tibial plateau fractures involving the posterior column

Abstract

Objective To investigate and evaluate the effects of treating type C3 tibial plateau fractures involving the posterior column by dual locking plate fixation via modified anterolateral and anteromedial approach.Methods We retrospectively studied 15 patients with type C3 tibial plateau fractures involving the posterior column that were treated in our hospital from March 2011 to December 2012.The group included 9 males and 6 females,aged from 27 to 56 years old (average 42.6 years old).All of the cases were closed fracture.During the treatment and follow-up period,the curative effect was evaluated by using Rasmussen's radiological grading for radiological outcomes at each follow-up and HSS grading for clinical examination about the knee joint function at the 12th follow-up.Results All patients obtained follow-up and the average follow-up time was 13.5 months (range,12-23 months).The average time for the whole operation,full weight bearing and fracture union were 196 min (range,120-210 min),11.6 weeks (range,8-20 weeks) and 13.8 weeks (range,12-16 weeks) respectively.No statistical difference was found in either the tibial plateau angle (TPA) or posterior slope angle (PA) when comparing the measuring results at instant,3rd month,6th month and 12th month on radiographies.All the results according to HSS grading are excellent and the mean score of the HSS grading was 89.5 (from 85 to 95); the mean score of the Rasmussen's radiological grading was 16.2 (range,14-18).Skin necrosis (about 4 cm) occurred at medial incision in one case at 2 week postoperatively.The patient was healed by debridement and negative pressure drainage.No complication,including infection,nonunion,reduction lost,fixation loosening,keen joint instability,iatrogenic injuries,occurred.Conclusion Treatment for type C3 tibial plateau fractures involving the posterior column by dual locking plate fixation via modified anterolateral and anteromedial approach is a feasible and effective method.Sufficient exposure,good reduction and fixation,earlier functional exercise can be achieved without several complications such as vascular and nerve injury and infection.The knee function recovered well and earlier curative effect was satisfied without noticeable TPA,PA loss and articular surface collapse during follow-up. Key words: Tibial fractures; Fracture fixation, internal; Internal fixators