Abstract
BackgroundMinimally invasive treatment of complex tibial plateau fracture represents one of the most challenging problems in orthopedic surgery. We intended to describe the percutaneous surgery involving an originally designed traction device which might facilitate the closed reduction for bicondylar tibial plateau fractures. Further, to assess the clinical outcomes of this minimally invasive technique.MethodsBetween December 2015 and July 2016, Twenty-one patients, mean age 43.71 ± 13.80 years, suffering from a bicondylar tibial plateau fracture (AO/OTA 41-type C) were included. All fractures were firstly reduced by skeletal traction with the aid of bidirectional rapid reductor, and residual depressed fragments were treated with minimally invasive bone tamp reduction. We then evaluated at a minimum follow-up of one year: (1) the rate of complications, (2) the radiographic outcomes (the amount of depression, tibial plateau widening, tibial plateau angle and posterior slope angle) and (3) the clinical outcome (Rasmussen scoring system).ResultsAll patients had their fractures healed without secondary displacement. No instrument-related complications occurred during operation. Post-operatively, superficial infection was found in two patients and donor-site morbidity was found in one patient. We observed a < 5 mm step-off in 100% of patients and a < 5 mm plateau widening in 95.5% of patients. Three patients were considered indicative of malalignment with TPA > 90° or PSA > 15°. At last evaluation, the Rasmussen clinical score was excellent in 11 patients (52.3%), good in 9 (42.9%) and fair in 1 (4.8%), and the radiological score was excellent in seven patients (33.3%), good in 14 (66.7%).ConclusionsThe bidirectional rapid reductor facilitates the minimally invasive treatment of bicondylar tibial plateau fracture. The patients exhibited excellent functional recovery. These results should be validated with a larger group of patients and longer period results.Trial registrationChiCTR-OPC-16008011.
Highlights
Invasive treatment of complex tibial plateau fracture represents one of the most challenging problems in orthopedic surgery
Traditional open reduction and internal fixation (ORIF) requires extensive soft tissue dissection, which may lead to numerous soft-tissue complications [6,7,8]
Based on the historical experience, the key factor of minimally invasive treatment for such injuries, we considered, was effective and persistent traction which allowed closed restoration of lower-extremity alignment during operation
Summary
Invasive treatment of complex tibial plateau fracture represents one of the most challenging problems in orthopedic surgery. We intended to describe the percutaneous surgery involving an originally designed traction device which might facilitate the closed reduction for bicondylar tibial plateau fractures. Because of articular comminution and the frequent occurrence soft-tissue injuries, clinical management still remains challenging for traumatic surgeons [3,4,5]. The Ilizarov technique allows a better choice of closed reduction and fixation which does not necessitate excessive soft-tissue stripping [9]. Today, this technique is being widely used in open and comminuted tibial plateau fractures. Frequent management of the circular frame was inconvenient for both patients and doctors
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