Locking compression plate plus small locking plate with short screws through limited posteromedial approach for complex tibial plateau fractures

Abstract

Objective To explore locking compression plate plus small locking plate with short screws through limited posteromedial approach for complex tibial plateau fractures. Methods We re-viewed 36 patients with complex tibial plateau fracture who had been treated from January 2010 to January 2015 and fully followed up at our department. They were 21 men and 15 women, 23 to 62 years of age (average, 42.3 years). By Schatzker classification, 21 cases were type Ⅴ and 15 type Ⅵ. The fractures were fixated by lateral locking compression plate plus small locking plate with short screws (3.5 mm) through limited posteromedial approach. The internal fixation was assessed by measuring the tibial plateau angle (TPA) and posterior slope angle (PA) on the X-ray films at immediate postoperation and 12 months after operation. At the final follow-ups, the knee flexion and extension were measured and functional recovery of the knee assessed using the Hospital for Special Surgery (HSS) score. Results The follow-up lasted from 12 to 33 months (mean, 15.8 months) in the 36 patients. No implant loosening or breakage or incision infection was observed. Fracture healing time ranged from 4.0 to 6.5 months (average, 4.6 months). No fracture failed to unite; the fracture alignment was fine without loss of reduction. The average TPA and PA at imme-diate postoperation (86.5°±1.3° and 9.5°±1.4°) were not significantly different from those at 12 months postoperation (85.8°±1.5° and 10.6°±1.2°) (P >0.05). According to the HSS scores at final follow-ups, 23 cases were rated as excellent, 8 as good, 4 as fair and one as poor, giving an excellent to good rate of 86.1%. At final follow-ups, the range of motion of the affected knee averaged 126.5° (from 95° to 140°). Conclusion Locking compression plate plus small locking plate with short screws through limited posteromedial approach is a fine treatment for complex tibial plateau fractures, resulting in reliable fixation, satisfactory functional recovery and limited complications. Key words: Tibial fractures; Knee joint; Fracture fixation, internal; Bone plates