Abstract
The posterolateral tibial plateau fracture was not easy to be exposed and fixed with usual techniques. The aim of this study was to investigate the biomechanical stability and clinical outcome of the isolated posterolateral tibial plateau fracture fixed with a single horizontal belt plate through the anterolateral supra-fibular-head approach. Fracture models were created by 18 synthetic tibias and fixed with three different fixation modes. Each group was fixed and tested on the loading machine, and final vertical displacement of the fragment was detected and calculated. Clinically, a retrospective analysis of 12 cases of posterolateral tibial plateau fracture from January 2013 to December 2017 was performed. There were 8 males and 4 females, aged 33-72 years, with an average age of 49.6 years. Isolated posterolateral tibial plateau fractures were identified according to preoperative X-ray and computed tomography scan. Through the modified anterolateral supra-fibular-head approach, the fracture was reduced and fixed by a prebending T-shaped distal radius plate and rafting screws, with bone substitute grafting or autogenous iliac bone implantation. Patients were followed up to a minimum one year of time period, and the outcome was evaluated clinically and radiologically. The biomechanical study shows that horizontal belt plate fixation for the isolated PL tibial plateau fracture can provide sufficient stability, allowing early knee functional exercise and partial weight bearing. For clinical case series, the average operation time in this group was 73.3 ± 10.2 mins (range: 55-90), and the average duration of hospitalization was 9.1 ± 3.3 days (range: 5-16). Patients were followed up for 12-24 months with an average of 16.5 months, and all patients achieved radiological fracture union after an average of 13.7 weeks. At one year after operation, the average knee score of the Hospital for Special Surgery (HSS) scale was 93.2 ± 4.2 points(range: 90-98), the average score of SMFA was 21.1 ± 5.6 points (range: 14-31), and the average knee range of motion (ROM) was 121.48° ± 8.88° (range: 105°-135°). There were 8 cases that were very satisfied and 3 cases that were satisfied with the operation. For an isolated posterolateral tibial plateau fracture, the supra-fibular-head approach can fully expose the fracture site; the horizontal belt plate fixation of the fracture is stable and reliable to allow for early-stage knee rehabilitation, and the outcome of medium-term clinical follow-up was satisfactory.
Highlights
A posterolateral fracture fragment (PLF) in tibial plateau fractures, either isolated or combined with other tibial plateau quadrants, is not uncommon and often necessitates surgical treatment [1,2,3,4,5]
Isolated PL tibial plateau fractures are relatively less common, with an incidence ranging from 7 to 14% [6, 7]. These injuries can be confirmed by computed tomography (CT) clinically, it is not easy to expose and fix the fracture using conventional methods, as the main parts of the fragments are usually covered by the fibular head and posterolateral corner structure (PLC), and several neurovascular bundles run across the popliteal cavity, which may interfere with exposure via a posterior incision
This study demonstrates that the horizontal belt plate fixation for the isolated PL tibial plateau fracture can provide sufficient stability for the PLF
Summary
A posterolateral fracture fragment (PLF) in tibial plateau fractures, either isolated or combined with other tibial plateau quadrants, is not uncommon and often necessitates surgical treatment [1,2,3,4,5]. Isolated PL tibial plateau fractures are relatively less common, with an incidence ranging from 7 to 14% [6, 7]. These injuries can be confirmed by computed tomography (CT) clinically, it is not easy to expose and fix the fracture using conventional methods, as the main parts of the fragments are usually covered by the fibular head and posterolateral corner structure (PLC), and several neurovascular bundles run across the popliteal cavity, which may interfere with exposure via a posterior incision. There are three major posterior approaches that are clinically used: (1) the PL approach, through the outer side of the lateral head of the gastrocnemius muscle and soleus, including osteotomy and nonosteotomy approaches, (2) the posteromedial approach, through the inner side of the medial head of the gastrocnemius muscle and soleus, and (3) the posterocentral approach, through the medial and lateral head of the gastrocnemius muscle in the popliteal cavity, which requires the anatomical separation of bundles of blood vessels and nerves
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