The modified posterolateral curved incision with double intermuscular approch in treating posterolateral tibial plateau fractures

Abstract

Objective To investigate the efficiency of the modified posterolateral curved incision with double intermuscular approach in the treatment of posterolateral tibial plateau fractures.Methods From August 2009 to March 2013,15 men and 17 women aged 28 to 77 (mean,46.25) years with posterolateral spitting or collapse tibial plateau fractures were treated to undergo a modified posterolateral approach.All types of fractures were closed,without nerve or artery injury.The duration from injury to fixation was 3-18 (mean,7.13) days.The modified posterolateral approach was preformed to expose tibial anterolateral condyle and posterolateral condyle through intermuscular space of anterior tibial muscle,popliteus muscle and soleus muscle.After open reduction,anterolateral fractures and posterolateral fractures were fixed by the T-shaped plate and Golf shaped plate respectively.Results All of the 32 patients were followed up from 6 months to 36 months (in average of 15.3 months).Postoperative X-ray showed satisfied fractures without obvious collapse of the articular surface.At the last follow-up,the Rasmussen scores were range from 6 to 18 (in average of 14.06),namely 14 cases excellent,15 cases good,3 cases fair.The knee joint functions were evaluated according to HSS.The HSS results showed that there were 12 cases excellent,16 cases good,3 cases fair and 1 case bad.None of the cases suffered from injuries of crucial blood vessel or nerves.No incision necrosis,wound infection or fixation failure occurred during follow-up.Conclusion Open reduction and internal fixation via modified posterolateral approach can expose posterolateral and anterolateral tibial plateau fracture in one incision.Fibular head osteotomy can be avoided.The present approach could also reduce surgical injury,minimize the possibilities of incision necrosis or plate exposure.The modified posterolateral approach can be recommended in clinical practice. Key words: Tibial fractures; Fracture fixation, internal; Internal fixators