Objective To explore the reduction and support effect of the subchondral screw compression technique for residual or secondary collapse of the lateral tibial plateau during operation. Methods Between January 2020 and June 2021, 11 patients with residual or secondary collapse of the lateral tibial plateau during operation were treated with the subchondral screw compression technique. There were 6 males and 5 females, aged 52.3 years old (range, 27-64 years). The fractures were caused by traffic accident in 10 cases and falling from height in 1 case and located at the left knee in 6 cases and the right knee in 5 cases. According to Schatzker classification, there were 5 cases of type Ⅱ fractures, 4 cases of type Ⅲ fractures, and 2 cases of type Ⅴfractures. According to the three columns classification, there were 5 cases of lateral column, 4 cases of lateral column and posterior column, and 2 cases of three columns. The time from injury to operation was 4.5 days (range, 3-7 days). During the follow-up, X-ray films were obtained and the Rasmussen standard was used to evaluate the quality of fracture reduction, meanwhile fracture healing was observed. The medial proximal tibial angle (mPTA), posterior tibial slope angle (pTSA), and articular surface collapse were measured at immediate and 12 months after operation. The knee joint range of motion was evaluated at last follow-up, and the knee joint function was evaluated using the Hospital for Special Surgery (HSS) score. Results All operations were successfully completed, with a mean operation time of 71.4 minutes (range, 55-120 minutes), and a mean hospital stay of 8.0 days (range, 5-13 days). The incisions all healed by first intention, without complications such as infection, flap necrosis, or vascular and nerve injury. All patients were followed up 16.5 months on average (range, 12-24 months). X-ray films showed that the fracture reduction score was 14-18 (mean, 16.7) according to Rasmussen score criteria; and 5 cases were rated as excellent and 6 as good. All fractures healed clinically with a mean clinical healing time of 14.9 weeks (range, 12-16 weeks), and there was no complications such as plate or screw loosening. At 12 months after operation, the mPTA and pTSA were (87.5±1.7)° and (6.2±3.1)°, respectively; there was no significant difference when compared to the values at immediate after operation [(87.6±1.8)° and (6.5±3.1)°] (P>0.05). The articular surface of the tibial plateaus was effectively supported, and it collapsed again by 0-1.0 mm at 12 months, with an average of 0.4 mm. At last follow-up, the knee joint range of motion was 115°-135° (mean, 126.8°) and the HSS score for knee joint function was 87-98 (mean, 93.9). Five patients underwent secondary operation to remove the internal fixator at 12-18 months after operation.ConclusionThe subchondral screw compression technique is helpful for the reduction of residual or secondary collapse of the lateral tibial plateau during operation, and can provide good support for osteochondral blocks.
Objective To investigate the cl inical effect of minimally invasive internal fixation percutaneous plate osteosynthesis (MIPPO) assisted by arthroscopy on tibial plateau fractures. Methods From September 2005 to December 2007, 29 patients with tibial plateau fracture underwent arthroscopy-assisted MIPPO, including 18 males and 11 females aged18-59 years old (average 34.7 years old). There were 8 cases of type II, 10 of type III, 5 of type IV, 3 of type V, and 3 of type VI according to Schatzker classification system. The fracture was combined with meniscus injury in 13 cases, anterior cruciate l igament injury in 4 cases, and medial collateral l igament injury in 3 cases. The time from injury to operation was 2-10 days. Firstly, the combined injury was treated under arthroscopy. Then, reduction of tibial plateau fractures was performed, bone grafting was conducted in the area of bone defect, and internal fixation using strut plates was performed after establ ishing subcutaneous tunnel via minimally invasion. Early rehabil itation activities were carried out for each patient 1 day after operation. Results No early compl ications such as poor heal ing of incisions, infections, and osteofascial compartment syndrome occurred. Over the follow-up period of 12-39 months (average 24 months), there was no failure of internal fixation, traumatic knee osteoarthritis, and inversion and eversion of the knee. The fractures healed within 3-4.5 months (average 3.5 months). The cl inical effect was excellent in 23 cases, good in 4 cases, and fair in 2 cases according to Lysholm knee rating system, and the excellent and good rate was 93.1%. Conclusion Arthroscopy-assisted MIPPO is a safe and effective way of managing tibial plateau fractures due to its features of minimal invasion, earl ier recovery, fewer compl ications, and simultaneous treatment of associated intra-articular injuries.
Objective To investigate the effectiveness of a new tibial plateau posterolateral column universal locking anatomical plate (hereinafter referred to as “new universal locking anatomical plate”) in the treatment of tibial plateau posterolateral column fractures. Methods Between October 2020 and December 2021, 14 patients with tibial plateau posterolateral column fracture were treated with a new universal locking anatomical plate. There were 7 males and 7 females with an average age of 59 years ranging from 29 to 75 years. There were 5 cases on the left side and 9 cases on the right side. The causes of injury included falling from height in 5 cases, traffic accident in 7 cases, and other injuries in 2 cases. The time from injury to operation ranged from 3 to 10 days, with an average of 6 days. According to Schatzker classification, there were 4 cases of type Ⅱ, 8 cases of type Ⅴ, and 2 cases of type Ⅵ. All fractures involved the posterolateral tibial plateau. Three column classification: two columns (anterolateral column+posterior column) in 4 cases, three columns in 10 cases. The operation time, intraoperative blood loss, fracture healing, and complications were recorded. The reduction of tibial plateau fracture was evaluated by Rasmussen radiographic score, and the recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score. Results All 14 cases completed the operation successfully. The operation time was 95-180 minutes, with an average of 154 minutes, and the intraoperative blood loss was 100-480 mL, with an average of 260 mL. All patients were followed up 6-19 months, with an average of 12.5 months. All fractures healed, and the healing time was 15-24 weeks, with an average of 18.7 weeks. During the follow-up, there was 1 case of common peroneal nerve palsy and 1 case of traumatic osteoarthritis. There was no other complication such as vascular injury, incision infection, deep venous thrombosis of lower limbs, heterotopic ossification, bone nonunion, and failure of internal fixation. The reduction of tibial plateau fractures was good immediately after operation, and the Rasmussen radiological score was 10-18, with an average of 15.7; 3 cases were excellent, 10 cases were good, and 1 case was fair, with an excellent and good rate of 92.9%. The scores and grades of HSS at 3 months after operation and at last follow-up significantly improved when compared with those before operation (P<0.05). There was no significant difference between 3 months after operation and last follow-up (P>0.05).Conclusion For the fractures involving the posterolateral column of the tibial plateau, the new universal locking anatomical plate can provide strong fixation, satisfactory postoperative fracture reduction, and good recovery of knee function.
ObjectiveTo introduce the surgery method to reset and fix tibial plateau fracture without opening joint capsule, and evaluate the safety and effectiveness of this method. MethodsBetween July 2011 and July 2013, 51 patients with tibial plateau fracture accorded with the inclusion criteria were included. All of 51 patients, 17 cases underwent open reduction and internal fixation without opening joint capsule in trial group, and 34 cases underwent traditional surgery method in control group. There was no significant difference in gender, age, cause of injury, time from injury to admission, side of injury, and types of fracture between 2 groups (P>0.05). The operation time, intraoperative blood loss, incision length, incision heal ing, and fracture healing were compared between 2 groups. The tibial-femoral angle and collapse of joint surface were measured on X-ray film. At last follow-up, joint function was evaluated with Hospital for Special Surgery (HSS) knee function scale. ResultsThe intraoperative blood loss in trial group was significantly less than that in control group (P<0.05). The incision length in trial group was significantly shorter than that in control group (P<0.05). Difference was not significant in operation time and the rate of incision heal ing between 2 groups (P>0.05). The patients were followed up 12-30 months (mean, 20.4 months) in trial group and 12-31 months (mean, 18.2 months) in control group. X-ray films indicated that all cases in 2 groups obtained fracture heal ing; there was no significant difference in the fracture healing time between 2 groups (t=1.382, P=0.173). On X-ray films, difference was not significant in tibial-femoral angle and collapse of joint surface between 2 groups (P>0.05). HSS score of the knee in trial group was significantly higher than that of control group (t=3.161, P=0.003). ConclusionIt can reduce the intraoperative blood loss and shorten the incision length to use open reduction and internal fixation without opening joint capsule for tibial plateau fracture. Traction of joint capsule is helpful in the reduction and good recovery of joint surface collapse. In addition, the surgery without opening joint capsule can avoid joint stiffness and obtain better joint function.
Objective To investigate the clinical effect of reconstructed bone xenograft plus buttress plate (T or L type) fixation in treating tibial plateau fracture. Methods From June 2001 to March 2003, 32 cases of tibial plateau fractures were treated by means of open reduction,reconstructed bone xenograft plus buttress plate (T or L type) fixation. There were 23 cases of bumper fracture, 5 cases of falling injury and 4 cases of crush injury by a weight; 20 males and 12 females, aged from 18 to 69 years with an average of 38 years. All patients had close fracture. Results All the patients were followed upfor 9 months to 23 months, tibial plateau fracture healed satisfactorily without sunken articular surface. According to Pasmussen criterion, the results were excellent in 16 knees, good in 12knees and moderate in 3 knees. The satisfactory rate was 87.5%. Conclusion Reconstructed bone xenograft plus buttress plate internal fixation has good effect in treating tibial plateau fractures because it can avoid the complication of transplantation of ilium.
ObjectiveTo evaluate the effect of nickel-titanium three-dimensional memory alloy mesh combined with autologous bone for living model of canine tibial plateau collapse fracture by biomechanical testing. MethodsSixteen healthy 12-month-old Beagle dogs were randomly divided into 4 group, 4 dogs in each group. The dogs were used to establish the tibial plateau collapse fracture model in groups A, B, and C. Then, the nickel-titanium three-dimensional memory alloy mesh combined with autologous bone (the fibula cortical bone particles), the artificial bone (nano-hydroxyapatite), and autologous fibula cortical bone particles were implanted to repair the bone defects within 4 hours after modeling in groups A, B, and C, respectively; and the plate and screws were fixed outside the bone defects. The dogs were not treated in group D, as normal control. At 5 months after operation, all animals were sacrificed and the tibial specimens were harvested and observed visually. The destructive axial compression experiments were carried out by the biomechanical testing machine. The displacement and the maximum failure load were recorded and the axial stiffness was calculated. ResultsAll animals stayed alive after operation, and all incisions healed. After 1-3 days of operation, the animals could stand and move, and no obvious limb deformity was found. The articular surfaces of the tibial plateau specimens were completely smooth at 5 months after operation. No obvious articular surface collapse was observed. The displacement and maximum failure load of specimens in groups A and D were significantly higher than those in groups B and C (P<0.05). But no significant difference was found between groups A and D and between groups B and C (P>0.05). ConclusionThe nickel-titanium three-dimensional memory alloy mesh combined with autologous bone for subarticular bone defect of tibial plateau in dogs has good biomechanical properties at 5 months after operation, and has better axial stiffness when compared with the artificial bone and autologous bone graft.
Objective To investigate the effectiveness of the reverse traction device in the preoperative treatment of high-energy tibial plateau fractures. Methods A retrospective study was conducted to analyze the clinical data of 33 patients with high-energy tibial plateau fractures who met the selection criteria between December 2020 and December 2023. All patients were treated by open reduction and internal fixation. According to the preoperative traction method, they were divided into the observation group (16 cases, treated with a reverse traction device on the day of admission) and the control group (17 cases, treated with heel traction on the day of admission). There was no significant difference in baseline data such as gender, age, body mass index, affected side, cause of injury, fracture Schatzker classification between the two groups (P>0.05). Preoperative waiting time, preoperative related complications (nail channel loosening, nail channel oozing, nail channel infection, soft tissue necrosis, soft tissue infection, deep vein thrombosis of the lower extremity, etc.), operation time, and total hospitalization time were recorded and compared between the two groups. On the 4th day after traction, visual analogue scale (VAS) score was used to evaluate the pain relief of the patients, the swelling value of the affected limb was measured, and the Immobilization Comfort Questionnaire (ICQ) score was used to evaluate the perioperative hospital comfort of the patients. Results Both groups of patients completed the operation successfully, and the operation time, total hospitalization time, and preoperative waiting time of the observation group were significantly less than those of the control group (P<0.05). There was no preoperative related complications in the observation group; in the control group, 3 patients had nail channel loosening and oozing, and 2 cases had the deep vein thrombosis of the lower extremity; the difference in the incidence of complication between the two groups was significant (P<0.05). On the 4th day after traction, the ICQ score, VAS score, and limb swelling value of the observation group were significantly better than those of the control group (P<0.05). X-ray films showed that the tibial plateau fracture separation and lower limb alignment recovered after calcaneal traction in the control group, but not as obvious as in the observation group. The fracture gap in the observation group significantly reduced, the tibial plateau alignment was good, and the lateral angulation deformity was corrected. Conclusion The use of reverse traction treatment in patients with high-energy tibial plateau fractures on admission can accelerate the swelling around the soft tissues to subside, reduce patients’ pain, shorten the preoperative waiting time, improve the patients’ preoperative quality of life, and contribute to the shortening of the operation time, with a good effectiveness.
【摘要】 目的 探讨复杂型胫骨平台骨折改良手术入路及双侧双钢板固定临床疗效。 方法 2006年3月—2008年12月，收治复杂型胫骨平台骨折21例，其中男14例，女7例；平均年龄37岁。按Schatzker骨折分类：Ⅴ型10例，Ⅵ型11例。均选择前外侧联合后内侧或后侧入路，双侧双钢板固定，术中探查半月板及交叉韧带损伤，一期修复处理及行交叉韧带重建。 结果 术后伤口Ⅰ期愈合19例，Ⅱ期愈合1例，1例术后10 d发生切口皮缘坏死，经换药后愈合。所有患者均获1~3年随访，平均19.5个月。骨性愈合时间5~10个月，平均7.4个月。出现创伤性关节炎2例，关节面塌陷2例，其中1例有轻度膝关节内翻。按美国特种外科医院评分标准：优18例，良2例，可1例，优良率95.2%。 结论 复杂型胫骨平台骨折运用前外侧联合后内或后侧切口入路，双侧双钢板固定，利于保护软组织血供、固定可靠稳定性好，是切实可行的有效方法。【Abstract】 Objective To study the clinical efficacy of modified surgical approach and bilateral double-plate fixation in the cases of complex tibial plateau fracture. Methods From March 2006 to December 2008, 21 patients with complex tibial plateau fracture, including 14 males and seven females, were treated in our hospital. The average age of them was 37 years old. Based on Schatzker fracture classification, there were 10 cases of type Ⅴ and 11 cases of type Ⅵ fracture. All the cases were treated by the combined anterolateral and posteromedial or posterior approaches and bilateral double-plate fixation. In the operation, we explored injuries on the meniscus and cruciate ligament, and carried out the one-stage rehabilitation and cruciate ligament reconstruction. Results There were 19 cases of one-stage healing, and one case of secondary healing. One patient suffered skin flap necrosis 10 days after the operation, and was cured after changing the medicine. All the patients were followed up for one to three years, averaging at 19.5 months. Bone healing occurred within 5 to 10 months averaging at 7.4 months. Two patients suffered traumatic arthritis; articular surface collapse was found in two patients; and one patient had mild varus knee. According to the scoring system from Hospital for Special Surgery, there were 18 cases of excellent efficacy, two of good efficacy, one of fair efficacy, with an excellence rate of 85.2%. Conclusion Combined anterolateral and posteromedial or posterior approaches and bilateral double-plate fixation for complex tibial plateau fractures is beneficial to protect the soft tissue blood supply and give reliable fixation stability. Thus, it is a feasible and effective method and is worth further research and popularizing in clinical practices.