Treatment of tibial plateau fractures with posterolateral collapse and posteromedial spilt

Abstract

Objective To explore the treatment of tibial plateau fractures with posterolateral collapse and posteromedial spilt. Methods During the period from January 2009 to January 2015, 17 tibial plateau fractures with posterolateral collapse and posteromedial spilt were surgically treated. They were 12 males and 5 females, with an average age of 32.4 years (from 21 to 52 years). Anteroposterior and lateral radiographs as well as computed tomography (CT) images were obtained in the course of preoperative radio-logical evaluation to determine the collapse and displacement. After the posteromedial bone spilt fragments were reduced and fixated via the posteromedial approach, the posterolateral collapse fragments were exposed via the fibular osteotomy approach and stabilized by lateral buttress following reduction. Hospital for Special Surgery (HSS) functional score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used at the final follow-ups to evaluate functional outcomes. Results Follow-ups with a mean duration of 18.3 months (range, from 12 to 24 months) were carried out in all the patients. All fractures healed within an average of 13.2 weeks (range, from 12 to 16 weeks). The HSS functional scores ranged from 60 to 100 points, averaging 89.6 points, giving 15 excellent cases, one good case and one fair case. The AOFAS functional scores ranged from 86 to 98 points, averaging 95.2 points. No loosening or breakage of the implants, or traumatic arthritis occurred in this series. Conclusion For tibial plateau fractures with posterolateral collapse and posteromedial spilt, a special type, it is an effective treatment to carry out open reduction and internal fixation of the posterolateral collapse fragments via the fibular osteotomy approach after reduction and stabilization of the posteromedial bone spilt fragments. Key words: Tibial fractures; Knee joint; Fracture fixation, internal; Osteotomy