Posteromedial approach for treatment of posterior bicondylar tibial plateau fractures

Abstract

Objective To explore the early clinical efficacy of posteromedial approach for treatment of posterior bicondylar tibial plateau fractures. Methods From October 2010 to December 2013, data of 13 patients of posterior bicondylar tibial plateau fracture who were treated with plate and screw fixation through posteromedial approach were retrospectively analyzed. There were8 males and 5 females, in which 7 cases located in the left knee and 6 cases located in the right knee, with an average age of 41.5±6.6 years. An inverted L shaped posteromedial incision was made in the operation. If the fracture line was involving the posteromedial condyle, a locking anatomical plate or L shaped compression plate was used. A 3.5 mm T shaped plate was used to support the posterolateral condyle. Allogeneic bone was used to support the articular surface in the cases with obvious bone defect. Rasmussen score was used for radiological assessment, and HSS knee score was used for efficacy assessment 12 months postoperative. An anteroposterior view and lateral view of the knee were obtained 2, 4, 12 weeks, 6 months and 12 months postoperation. The fracture healing time was judged by X-ray and clinical examinations, additionally, the complications and corre-sponding outcomes were also recorded. Results All 13 patients had obtained an average of 20.8±9.4 months follow-up (range, 8-34 months), and all fractures were healed. The healing time in terms of X-ray was 12 to 24 weeks (mean, 15.6±5.2 weeks). After surgery, the Rasmussen score was 1-18 points (mean 15.8 points). 7 cases achieved excellent results, 4 good, and 2 fair. The excellent and good rate was 84.6%. HSS knee score improved significantly from 38.2±7.8 points (range, 26-48 points) to 85.2±7.8 points (range, 56-92 points) 12 months postoperation, and the results was excellent in 9 cases, good in 2, fair in 1 and poor in 1, with total excellence and good result of 84.6%. The range of knee activity was 95°-130°. None of the skin and soft tissue complications such as infection, breakage of screw loosening occurred at the time of the latest follow-up, but two cases got chronic pain in the knee postoperation. In the follow-up period, a mild knee gap narrows had been observed in one patient and traumatic arthritis was diagnosed. The pain was partial relieved by oral non-steroidal drugs and intra-articular injection of Sodium Hyaluronate. The other one's pain was significantly relieved by oral non-steroidal drugs, and X ray film shows the knee joint gap has no obvious narrow. Conclusion Posteromedial approach for treatment of posterior bicondylar tibial plateau fractures can obtain a satisfactory therapeutic effect. Key words: Tibial fractures; Fracture fixation, internal; Treatment outcome