Effectiveness analysis of surgical treatment of Schatzker type <b>Ⅳ</b> tibial plateau fractures _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAN Bingshan , YIN Wangping , ZHANG Xinchao , LIU Dechang , GUI Keke , SUN Jianwei , CHEN Yanchao ,  NI Miaozhong

Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, 201508, P.R.China;

Corresponding author：

NI Miaozhong, Email: nmz_1978@126.com

Keywords：

Tibial plateau fracture; Schatzker type Ⅳ; internal fixation

DOI：

10.7507/1002-1892.201704142

Video：

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Objective To introduce a surgical protocol based on the location and orientation of the apex of the medial condylar fracture line for the treatment of Schatzker type Ⅳ tibial plateau fractures and report the preliminary effectiveness. Methods The clinical data of 18 patients with Schatzker type Ⅳ tibial plateau fractures underwent open reduction and internal fixation between March 2012 and April 2016 were retrospectively analysed. There were 6 males and 12 females, aged 36-74 years (mean, 45 years). The causes of injury included traffic accident in 2 cases, falling in 14 cases, bruise injury in 1 case, and crush injury of heavy object in 1 case. All cases were fresh closed fractures, without injury of nerves and blood vessels. According to sub type of Wahlquist tibial plateau type Ⅳ fracture classification, there were 1 case of type A, 5 cases of type B, and 12 cases of type C. The interval of injury and operation was 6-16 days (mean, 9.5 days). The location of the apex of the medial condylar fracture line was determined the surgical approach. After operation, reduction of tibial plateau fractures was evaluated by the DeCoster score evaluation criteria. The knee joint function was assessed by short Musculoskeletal Function Assessment (SMFA) score and Hospital for Special Surgery (HSS) score. Results The incisions all healed by first intension after operation without surgery related complications. All the patients obtained satisfactory exposure and reduction during operation. According to DeCoster score evaluation criteria, the results were excellent in 13 cases and fair in 5 cases. All the patients were followed up 12-30 months (mean, 18 months). X-ray films showed that all fractures healed at 10-16 weeks (mean, 12 weeks) after operation. There was no plate displacement, screw loosening, and other complications occurred during follow-up. At last follow-up, the SMFA score was 15-48 (mean, 28.5). The HSS score was 52-94 (mean, 81.1), and the results were excellent in 10 cases, good in 5 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 83.3%; the main clinical manifestation was severe traumatic osteoarthritis symptom in 1 case with the fair result. Conclusion The surgical program should be developed based on the location and orientation of the apex of the medial condylar fracture line. Open reduction and internal fixation for treating Schatzker type Ⅳ fractures can achieve satisfactory effectiveness.

Citation： YAN Bingshan, YIN Wangping, ZHANG Xinchao, LIU Dechang, GUI Keke, SUN Jianwei, CHEN Yanchao, NI Miaozhong. Effectiveness analysis of surgical treatment of Schatzker type Ⅳ tibial plateau fractures . Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1305-1310. doi: 10.7507/1002-1892.201704142 Copy

1.	Lee MH, Hsu CJ, Lin KC, et al. Comparison of outcome of unilateral locking plate and dual plating in the treatment of bicondylar tibial plateau fractures. J Orthop Surg Res, 2014, 9: 62.
2.	Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, (138): 94-104.
3.	Yang G, Zhu Y, Luo C, et al. Morphological characteristics of Schatzker type Ⅳ tibial plateau fractures: a computer tomography based study. Int Orthop, 2012, 36(11): 2355-2360.
4.	Haider SJ, Pean CA, Davidovitch RI, et al. Functional Outcomes of Isolated Medial Tibial Plateau Fractures. J Knee Surg, 2016, 29(5): 414-422.
5.	Sciadini MF, Sims SH. Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type Ⅳ tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma, 2013, 27(1): e18-23.
6.	Wahlquist M, Iaguilli N, Ebraheim N, et al. Medial tibial plateau fractures: a new classification system. J Trauma, 2007, 63(6): 1418-1421.
7.	宗双乐, 苏立新, 李力更, 等. 经后外侧反弧形切口双肌间隙入路治疗后外侧胫骨平台塌陷骨折. 中国修复重建外科杂志, 2016, 30(9): 1076-1080.
8.	张世民, 姚勐炜, 张立智, 等. 胫骨平台双髁四象限骨折的切开复位内固定治疗近期疗效观察. 中国矫形外科杂志, 2013, 21(18): 1808-1815.
9.	胡勇, 尹宗生, 张辉, 等. 累及后柱的胫骨平台骨折的手术治疗. 中华骨科杂志, 2012, 32(12): 1138-1144.
10.	Moore TM. Fracture—dislocation of the knee. Clin Orthop Relat Res, 1981, (156): 128-140.
11.	Brunner A, Horisberger M, Ulmar B, et al. Classiﬁcation systems for tibial plateau fractures; Does computed tomography scanning improve their reliability? Injury, 2010, 41: 173-178.
12.	Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11): 683-692.
13.	Chang SM, Zhang YQ, Yao MW, et al. Schatzker type Ⅳ medial tibial plateau fractures: a computed tomography-based morpho-logical subclassification. Orthopedics, 2014, 37(8): e699-706.
14.	陈文龙, 张英琪, 张世民. Schatzker Ⅳ型胫骨平台骨折及手术入路研究. 国际骨科学杂志, 2014, 35(2): 97-99.
15.	王军, 赵春鹏, 李庭, 等. 骨折脱位型胫骨平台骨折发生率及内侧和后内侧骨块影像学特点. 中华创伤杂志, 2015, 31(5): 427-430.
16.	Barei DP, O’Mara TJ, Taitsman LA, et al. Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma, 2008, 22(3): 176-182.
17.	胡孙君, 张世民, 张英琪, 等. 胫骨平台后外侧象限骨折手术入路的深层解剖及后外侧与后内侧比较. 中国临床解剖学杂志, 2015, 33(5): 497-501.
18.	Ruffolo MR, Gettys FK, Montijo HE, et al. Complications of high-energy bicondylar tibial plateau fractures treated with dual plating through 2 incisions. J Orthop Trauma, 2015, 29(2): 85-90.
19.	Bagherifard A, Jabalameli M, Hadi H, et al. Surgical Management of Tibial Plateau Fractures With 3.5 mm Simple Plates. Trauma Mon, 2016, 21(2): e26733.
20.	姚勐炜, 郭震, 张世民, 等. 膝关节后内侧倒" L”形单切口治疗胫骨平台双后髁骨折. 中华创伤骨科杂志, 2015, 17(3): 271-273.
21.	Qiu WJ, Zhan Y, Sun H, et al. A posterior reversed L-shaped approach for the tibial plateau fractures-A prospective study of complications (95 cases). Injury, 2015, 46(8): 1613-1618.
22.	Espinoza-Ervin CZ, Starr AJ, Reinert CM, et al. Use of a midline anterior incision for isolated medial tibial plateau fractures. J Orthop Trauma, 2009, 23(2): 148-153.
23.	Hoekstra H, Rosseels W, Luo CF, et al. A combined posterior reversed L-shaped and anterolateral approach for two column tibial plateau fractures in Caucasians: A technical note. Injury, 2015, 46(12): 2516-2519.
24.	Chang SM, Wang X, Zhou JQ, et al. Posterior coronal plating of bicondylar tibial plateau fractures through posteromedial and anterolateral approaches in a healthy floating supine position. Orthopedics, 2012, 35(7): 583-588.
25.	Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma, 2005, 19(2): 79-84.
26.	Berkes MB, Little MT, Schottel PC, et al. Outcomes of Schatzker Ⅱ tibial plateau fracture open reduction internal fixation using structural bone allograft. J Orthop Trauma, 2014, 28(2): 97-102.

1. Lee MH, Hsu CJ, Lin KC, et al. Comparison of outcome of unilateral locking plate and dual plating in the treatment of bicondylar tibial plateau fractures. J Orthop Surg Res, 2014, 9: 62.
2. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, (138): 94-104.
3. Yang G, Zhu Y, Luo C, et al. Morphological characteristics of Schatzker type Ⅳ tibial plateau fractures: a computer tomography based study. Int Orthop, 2012, 36(11): 2355-2360.
4. Haider SJ, Pean CA, Davidovitch RI, et al. Functional Outcomes of Isolated Medial Tibial Plateau Fractures. J Knee Surg, 2016, 29(5): 414-422.
5. Sciadini MF, Sims SH. Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type Ⅳ tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma, 2013, 27(1): e18-23.
6. Wahlquist M, Iaguilli N, Ebraheim N, et al. Medial tibial plateau fractures: a new classification system. J Trauma, 2007, 63(6): 1418-1421.
7. 宗双乐, 苏立新, 李力更, 等. 经后外侧反弧形切口双肌间隙入路治疗后外侧胫骨平台塌陷骨折. 中国修复重建外科杂志, 2016, 30(9): 1076-1080.
8. 张世民, 姚勐炜, 张立智, 等. 胫骨平台双髁四象限骨折的切开复位内固定治疗近期疗效观察. 中国矫形外科杂志, 2013, 21(18): 1808-1815.
9. 胡勇, 尹宗生, 张辉, 等. 累及后柱的胫骨平台骨折的手术治疗. 中华骨科杂志, 2012, 32(12): 1138-1144.
10. Moore TM. Fracture—dislocation of the knee. Clin Orthop Relat Res, 1981, (156): 128-140.
11. Brunner A, Horisberger M, Ulmar B, et al. Classiﬁcation systems for tibial plateau fractures; Does computed tomography scanning improve their reliability? Injury, 2010, 41: 173-178.
12. Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11): 683-692.
13. Chang SM, Zhang YQ, Yao MW, et al. Schatzker type Ⅳ medial tibial plateau fractures: a computed tomography-based morpho-logical subclassification. Orthopedics, 2014, 37(8): e699-706.
14. 陈文龙, 张英琪, 张世民. Schatzker Ⅳ型胫骨平台骨折及手术入路研究. 国际骨科学杂志, 2014, 35(2): 97-99.
15. 王军, 赵春鹏, 李庭, 等. 骨折脱位型胫骨平台骨折发生率及内侧和后内侧骨块影像学特点. 中华创伤杂志, 2015, 31(5): 427-430.
16. Barei DP, O’Mara TJ, Taitsman LA, et al. Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma, 2008, 22(3): 176-182.
17. 胡孙君, 张世民, 张英琪, 等. 胫骨平台后外侧象限骨折手术入路的深层解剖及后外侧与后内侧比较. 中国临床解剖学杂志, 2015, 33(5): 497-501.
18. Ruffolo MR, Gettys FK, Montijo HE, et al. Complications of high-energy bicondylar tibial plateau fractures treated with dual plating through 2 incisions. J Orthop Trauma, 2015, 29(2): 85-90.
19. Bagherifard A, Jabalameli M, Hadi H, et al. Surgical Management of Tibial Plateau Fractures With 3.5 mm Simple Plates. Trauma Mon, 2016, 21(2): e26733.
20. 姚勐炜, 郭震, 张世民, 等. 膝关节后内侧倒" L”形单切口治疗胫骨平台双后髁骨折. 中华创伤骨科杂志, 2015, 17(3): 271-273.
21. Qiu WJ, Zhan Y, Sun H, et al. A posterior reversed L-shaped approach for the tibial plateau fractures-A prospective study of complications (95 cases). Injury, 2015, 46(8): 1613-1618.
22. Espinoza-Ervin CZ, Starr AJ, Reinert CM, et al. Use of a midline anterior incision for isolated medial tibial plateau fractures. J Orthop Trauma, 2009, 23(2): 148-153.
23. Hoekstra H, Rosseels W, Luo CF, et al. A combined posterior reversed L-shaped and anterolateral approach for two column tibial plateau fractures in Caucasians: A technical note. Injury, 2015, 46(12): 2516-2519.
24. Chang SM, Wang X, Zhou JQ, et al. Posterior coronal plating of bicondylar tibial plateau fractures through posteromedial and anterolateral approaches in a healthy floating supine position. Orthopedics, 2012, 35(7): 583-588.
25. Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma, 2005, 19(2): 79-84.
26. Berkes MB, Little MT, Schottel PC, et al. Outcomes of Schatzker Ⅱ tibial plateau fracture open reduction internal fixation using structural bone allograft. J Orthop Trauma, 2014, 28(2): 97-102.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of surgical treatment of Schatzker type Ⅳ tibial plateau fractures

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