Reduction and fixation via posteromedial and anterolateral approaches for complex tibial fractures associated with collapse of posterolateral articular surface

Abstract

Objective To explore the treatment of complex tibial fractures associated with collapse of posterolateral articular surface (Schatzker types Ⅵ and Ⅴ) using reduction via posteromedial and antero-lateral approaches. Methods From July 2010 to September 2012, 19 patients with complex tibial frac-ture were treated and followed up by our department. They were 11 males and 8 females, with an average age of 49.5 years (range, from 30 to 65 years). Their fractures were classified as Schatzker type V in 14 cases and Schatzker type Ⅵ in 5. All fractures involved the posterolateral tibial plateau. They were all reduced via the posteromedial and anterolateral approaches. The posterolateral cortical fragments were pushed anteriorly and a curved reconstruction plate was used to maintain the reduction via the posteromedial approach. An anatomically designed plate was lastly placed on the anterolateral side of the proximal tibia to fix the lateral articular surface of the proximal tibia. The knee function was evaluated by The Hospital fou Special Surgery Score(HSS) at the last follow-ups. Results The mean operation time was 164.7 min (range, from 120 to 280 min). All fractures united clinically and radiographically after an average time of 15.2 weeks (range, from 12 to 18 weeks). No nonunion, injury to the common peroneal nerve, varus deformity, implant failure, or no deep wound infection occurred. At immediate postoperation and one year postoperation, the mean tibial plateau angle (TPA) was 87.2°±1.0° and 87.1°±1.1° , and the mean posterior slope angle (PSA) was 7.0°±1.1° and 7.0°±1.0° , respectively, showing no significant difference between the 2 time points (P>0.05). At one year postoperation, the average motion of the affected knee was 128.7° (range, from 0 to 135°). The posterolateral tibial articular malreduction (≥2 mm step-off) was seen in 2 patients. The mean HSS score at the last follow-ups was 92.6 (range, from 88 to 97). Conclusions Posterolateral fragments in complex tibial plateau fractures can be reduced and fixed via the posteromedial and anterolateral ap-proaches, and can be fixed by a posterolateral buttress plate through the posteromedial approach and by an anterolateral locking plate. This is a safe and effective treatment for posterolateral tibial plateau fractures al-ternatively. Key words: Knee joint; Froctures, bone; Fracture fixation, internal; Bone plates