Clinical observation of 3.5 mm T support plate fixation for simple posterolateral tibial plateau fracture by posterolateral inverted L-shaped approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YANG Xiaohai , XU Feng , YIN Zifei , WANG Qing

Department of Orthopedics, Traditional Chinese Medicine Hospital of Kunshan, Kunshan Jiangsu, 215300, P.R.China;

Corresponding?author：

YANG Xiaohai, Email: doctoryxh@163.com

Keywords：

Tibial plateau fracture; posterolateral approach; T support plate; internal fixation

DOI：

10.7507/1002-1892.201611071

Video：

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Objective To summarize the effectiveness of 3.5 mm T support plate fixation for simple postero-lateral tibial plateau fractures by posterolateral inverted L-shaped approach. Methods Between March 2011 and January 2016, 13 patients with simple posterolateral tibial plateau fracture were treated with 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach. Of 13 cases, 6 were male and 7 were female, aged 28 to 52 years (mean, 43 years). The left side was involved in 5 cases and the right side in 8 cases. The causes of injury were traffic accidents in 6 cases, falls in 3 cases, and falling from height in 4 cases. All of patients had fresh closed fracture by X-ray, CT three dimensional reconstruction, and MRI. According to Schatzker classification, 4 cases were rated as type II and 9 cases as type III. The time between injury and operation was 5-9 days (mean, 7 days). Results One case had incision skin necrosis, which was cured after debridement and skin grafting; and primary healing was obtained in the other cases. The patients were followed up 10-16 months (mean, 13 months). The X-ray film showed that the fracture line was blurred at 3 months after operation, and disappeared at 12 months after operation. There was no complications of wound infection, major neurovascular injury, loosening or breakage of internal fixation, and dislocation of joint surface. The Hospital for Special Surgery (HSS) knee function score was 94 (range, 89-97) at last follow-up; all were excellent. Conclusion The 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach is one of preferred surgical method for the treatment of simple posterolateral tibial plateau fractures.

Citation： YANG Xiaohai, XU Feng, YIN Zifei, WANG Qing. Clinical observation of 3.5 mm T support plate fixation for simple posterolateral tibial plateau fracture by posterolateral inverted L-shaped approach. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 815-819. doi: 10.7507/1002-1892.201611071 Copy

1.	Partenheimer A, Gosling T, Muller M, et al. Management of bicondylar fractures of the tibial plateau withunilateral fixed-angle plate fixation. Unfallchirurg, 2007, 110(8): 675-683.
2.	Bhattacharyya T, McCarty LP 3rd, Harris MB, et al. The posteriorshearingtibial plateau fracture: treatment and results via aposterior approach. J Orthop Trauma, 2005, 19(5): 305-310.
3.	毛玉江, 張伯松, 公茂琪, 等. 200 例脛骨平臺骨折的骨折形態及損傷機制分析.中華創傷骨科雜志, 2016, 18(1): 47-51.
4.	Schatzker J, McBroom R, Bruce D. The tibia plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, 138: 94-104.
5.	劉云鵬, 劉沂. 骨與關節損傷和疾病的診斷分類及功能評定標準. 北京: 清華大學出版社, 2002: 233.
6.	Tao J, Hang DH, Wang QG, et al. The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee, 2008, 15(6): 473-479.
7.	Sun H, Luo CF, Yang G, et al. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol, 2013, 23(7): 809-818.
8.	俞光榮, 夏江, 周家鈴, 等. 改良前外側入路脛骨近端鎖定加壓鋼板固定治療脛骨平臺后外側骨折. 中華骨科雜志, 2013, 33(9): 390-392.
9.	Chen HW, Zhou SH, Liu GD, et al. An extended anterolateral approach for posterolateral tibial plateau fractures. Knee, 2015, 23(12): 3750-3755.
10.	Solomon LB, Stevenson AW, Lee YC, et al. Posterolateral and anterolateral approaches to unicondylar posterolateral tibial plateau fractures: a comparative study. Injury, 2013, 44(11): 1561-1568.
11.	邱偉建, 包德明, 王馭愷, 等. 后內側倒" L”形切口聯合前外側切口治療復雜脛骨平臺骨折. 中華創傷骨科雜志, 2016, 18(10): 840-844.
12.	Garner MR, Warner SJ, Lorich DG. Surgical approaches to posterolateral tibial plateau fractures. J Knee Surg, 2016, 29(1): 12-20.
13.	Pires RE, GioIdano V, Wajnsztejn A, et al. Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau. Injury, 2016, 47(10): 2320-2325.
14.	Chang SM, Zheng HP, Li HF, et al. Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg, 2009, 129(7): 955-962.
15.	Carlson DA. Posterior bicondylartibial plateau fractures. J Orthop Trauma, 2005, 19(2): 73-78.
16.	馮沖, 賈代良, 雷學鋒, 等. T 形鎖定鋼板經 Carlson 后外側入路置入修復脛骨平臺后外側骨折: 12 個月隨訪評價. 中國組織工程研究, 2016, 20(17): 2511-2517.
17.	Heidari N, Lidder S, Grechenig W, et al. The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau: a cadaver study. J Orthop Trauma, 2013, 27(4): 221-225.
18.	宋春健, 孫輝, 楊光, 等. 膝關節后外側倒" L”形徑路放置支撐鋼板時有效及安全性. 中國組織工程研究, 2015, 19(53): 8585-8590.
19.	范鑫斌, 張巖, 楊鐵毅, 等. 脛骨平臺后外側骨折 3 種內固定方式的有限元分析. 中國組織工程研究, 2014, 18(22): 3510-3516.
20.	Zhang W, Luo CF, Putnis S, et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee, 2012, 19(2): 94-98.

1. Partenheimer A, Gosling T, Muller M, et al. Management of bicondylar fractures of the tibial plateau withunilateral fixed-angle plate fixation. Unfallchirurg, 2007, 110(8): 675-683.
2. Bhattacharyya T, McCarty LP 3rd, Harris MB, et al. The posteriorshearingtibial plateau fracture: treatment and results via aposterior approach. J Orthop Trauma, 2005, 19(5): 305-310.
3. 毛玉江, 張伯松, 公茂琪, 等. 200 例脛骨平臺骨折的骨折形態及損傷機制分析.中華創傷骨科雜志, 2016, 18(1): 47-51.
4. Schatzker J, McBroom R, Bruce D. The tibia plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, 138: 94-104.
5. 劉云鵬, 劉沂. 骨與關節損傷和疾病的診斷分類及功能評定標準. 北京: 清華大學出版社, 2002: 233.
6. Tao J, Hang DH, Wang QG, et al. The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee, 2008, 15(6): 473-479.
7. Sun H, Luo CF, Yang G, et al. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol, 2013, 23(7): 809-818.
8. 俞光榮, 夏江, 周家鈴, 等. 改良前外側入路脛骨近端鎖定加壓鋼板固定治療脛骨平臺后外側骨折. 中華骨科雜志, 2013, 33(9): 390-392.
9. Chen HW, Zhou SH, Liu GD, et al. An extended anterolateral approach for posterolateral tibial plateau fractures. Knee, 2015, 23(12): 3750-3755.
10. Solomon LB, Stevenson AW, Lee YC, et al. Posterolateral and anterolateral approaches to unicondylar posterolateral tibial plateau fractures: a comparative study. Injury, 2013, 44(11): 1561-1568.
11. 邱偉建, 包德明, 王馭愷, 等. 后內側倒" L”形切口聯合前外側切口治療復雜脛骨平臺骨折. 中華創傷骨科雜志, 2016, 18(10): 840-844.
12. Garner MR, Warner SJ, Lorich DG. Surgical approaches to posterolateral tibial plateau fractures. J Knee Surg, 2016, 29(1): 12-20.
13. Pires RE, GioIdano V, Wajnsztejn A, et al. Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau. Injury, 2016, 47(10): 2320-2325.
14. Chang SM, Zheng HP, Li HF, et al. Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg, 2009, 129(7): 955-962.
15. Carlson DA. Posterior bicondylartibial plateau fractures. J Orthop Trauma, 2005, 19(2): 73-78.
16. 馮沖, 賈代良, 雷學鋒, 等. T 形鎖定鋼板經 Carlson 后外側入路置入修復脛骨平臺后外側骨折: 12 個月隨訪評價. 中國組織工程研究, 2016, 20(17): 2511-2517.
17. Heidari N, Lidder S, Grechenig W, et al. The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau: a cadaver study. J Orthop Trauma, 2013, 27(4): 221-225.
18. 宋春健, 孫輝, 楊光, 等. 膝關節后外側倒" L”形徑路放置支撐鋼板時有效及安全性. 中國組織工程研究, 2015, 19(53): 8585-8590.
19. 范鑫斌, 張巖, 楊鐵毅, 等. 脛骨平臺后外側骨折 3 種內固定方式的有限元分析. 中國組織工程研究, 2014, 18(22): 3510-3516.
20. Zhang W, Luo CF, Putnis S, et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee, 2012, 19(2): 94-98.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical observation of 3.5 mm T support plate fixation for simple posterolateral tibial plateau fracture by posterolateral inverted L-shaped approach

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