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, 张伯松, 公茂琪, 等. 200 例胫骨平台骨折的骨折形态及损伤机制分析.中华创伤骨科杂志, 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.	刘云鹏, 刘沂. 骨与关节损伤和疾病的诊断分类及功能评定标准. 北京: 清华大学出版社, 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.	俞光荣, 夏江, 周家铃, 等. 改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折. 中华骨科杂志, 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.	邱伟建, 包德明, 王驭恺, 等. 后内侧倒" L”形切口联合前外侧切口治疗复杂胫骨平台骨折. 中华创伤骨科杂志, 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.	冯冲, 贾代良, 雷学锋, 等. T 形锁定钢板经 Carlson 后外侧入路置入修复胫骨平台后外侧骨折: 12 个月随访评价. 中国组织工程研究, 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, 孙辉, 杨光, 等. 膝关节后外侧倒" L”形径路放置支撑钢板时有效及安全性. 中国组织工程研究, 2015, 19(53): 8585-8590.
19.	范鑫斌, 张岩, 杨铁毅, 等. 胫骨平台后外侧骨折 3 种内固定方式的有限元分析. 中国组织工程研究, 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, 张伯松, 公茂琪, 等. 200 例胫骨平台骨折的骨折形态及损伤机制分析.中华创伤骨科杂志, 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. 刘云鹏, 刘沂. 骨与关节损伤和疾病的诊断分类及功能评定标准. 北京: 清华大学出版社, 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. 俞光荣, 夏江, 周家铃, 等. 改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折. 中华骨科杂志, 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. 邱伟建, 包德明, 王驭恺, 等. 后内侧倒" L”形切口联合前外侧切口治疗复杂胫骨平台骨折. 中华创伤骨科杂志, 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. 冯冲, 贾代良, 雷学锋, 等. T 形锁定钢板经 Carlson 后外侧入路置入修复胫骨平台后外侧骨折: 12 个月随访评价. 中国组织工程研究, 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, 孙辉, 杨光, 等. 膝关节后外侧倒" L”形径路放置支撑钢板时有效及安全性. 中国组织工程研究, 2015, 19(53): 8585-8590.
19. 范鑫斌, 张岩, 杨铁毅, 等. 胫骨平台后外侧骨折 3 种内固定方式的有限元分析. 中国组织工程研究, 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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