Osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in treatment of tibial plateau fractures involving posterolateral column collapse_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PEI Xuan ^1,2 , WANG Guodong ¹ ^△ , QIAN Shenglong ¹ , CHENG Yipeng ^1,2 , FANG Zhixun ^1,3 , KE Xi ¹ ,  LIU Ximing ¹

1. Department of Orthopedics, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430070, P. R. China;
2. School of Medicine, Wuhan University of Science and Technology, Wuhan Hubei, 430081, P. R. China;
3. First School of Clinical Medicine, Southern Medical University, Guangzhou Guangdong, 510515, P. R. China;

Corresponding author：

LIU Ximing, Email: gklxm@163.com

Keywords：

Tibial plateau fracture; osteotomy; reduction; internal fixation

DOI：

10.7507/1002-1892.202301019

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Objective To investigate the effectiveness of osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in the treatment of tibial plateau fractures involving posterolateral column collapse. Methods A clinical data of 23 patients with tibial plateau fractures involving posterolateral column collapse, who had undergone osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation between January 2015 and June 2021, was retrospectively analyzed. There were 14 males and 9 females with an average age of 42.6 years ranging from 26 to 62 years. The causes of injury included traffic accident in 16 cases, falling from height in 5 cases, and other injuries in 2 cases. According to Schatzker classification, there were 15 cases of type Ⅴ and 8 cases of type Ⅵ. The time from injury to operation was 4-8 days with an average of 5.9 days. The operation time, intraoperative blood loss, fracture healing time, and complications were recorded. The depth of articular surface collapse of posterolateral column and posterior inclination angle (PSA) of the tibial plateau were compared before operation and at 2 days and 6 months after operation; fracture reduction of tibial plateau fracture was evaluated by Rasmussen anatomic score. The recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score at 2 days and 6 months after operation. Results All 23 patients were completed the operation successfully. The operation time was 120-195 minutes, with an average of 152.8 minutes; the intraoperative blood loss was 50-175 mL, with an average of 109.5 mL. All patients were followed up 12-24 months, with an average of 16.7 months. One patient had superficial wound infection after operation, and the incision healed after dressing change; primary healing of incision of other patients was obtained. The fracture healing time was 12-18 weeks, with an average of 13.7 weeks. No failure of internal fixation, varus and valgus deformity of the knee joint, and instability of the knee joint was found at last follow-up. One patient developed joint stiffness and the range of motion of the knee joint was 10°-100°; the range of motion of the knee joint of other patients was 0°-125°. At 2 days and 6 months after operation, the depth of articular surface collapse of posterolateral column, PSA, and Rasmussen anatomic scores significantly improved when compared with those before operation (P<0.05). There was no significant difference between the two postoperative time points (P>0.05). The HSS score at 6 months after operation was significantly higher than that at 2 days after operation (P<0.05). Conclusion For tibial plateau fractures involving posterolateral column collapse, reduction and internal fixation through osteotomy of non-core weight-bearing area of the lateral tibial plateau has the advantages of fully expose the posterolateral column fragment, good articular surface reduction, sufficient bone grafting, and fewer postoperative complications. It is beneficial to restore knee joint function and can be widely used in clinic.

Citation： PEI Xuan, WANG Guodong, QIAN Shenglong, CHENG Yipeng, FANG Zhixun, KE Xi, LIU Ximing. Osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in treatment of tibial plateau fractures involving posterolateral column collapse. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 410-416. doi: 10.7507/1002-1892.202301019 Copy

1.	Sohn HS, Yoon YC, Cho JW, et al. Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures. J Orthop Trauma, 2015, 29(2): 91-97.
2.	Zhang Y, Song L, Li X, et al. Flexion-valgus unicondylar tibial plateau depression fracture pattern: Classification and treatment. Injury, 2018, 49(4): 852-859.
3.	Sim JA, Park JH, Na YG, et al. Three-column subdivision for isolated posterolateral tibial plateau fractures and perspective surgical approaches. Knee, 2021, 33: 93-101.
4.	Wang Y, Luo C, Zhu Y, et al. Updated three-column concept in surgical treatment for tibial plateau fractures-A prospective cohort study of 287 patients. Injury, 2016, 47(7): 1488-1496.
5.	汪国栋, 刘培钊, 刘曦明. 后外侧胫骨平台骨折手术入路之热点问题探讨. 创伤外科杂志, 2021, 23(10): 721-727.
6.	Cho JW, Kim J, Cho WT, et al. Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures: a review with an emphasis on rim plating via modified anterolateral approach. Int Orthop, 2017, 41(9): 1887-1897.
7.	胡孙君, 杜守超, 李世杰, 等. 胫骨平台后外侧骨折的手术入路与内固定治疗技术的研究进展. 国际骨科学杂志, 2022, 43(1): 12-17.
8.	明安世, 汪洁, 朱登峰, 等. 选择性胫骨外髁U形截骨入路治疗胫骨外侧平台塌陷粉碎骨折. 中国骨伤, 2022, 35(6): 560-565.
9.	焦竞, 黄玉成, 肖飞, 等. 3D打印截骨导板结合 “栅栏” 螺钉技术治疗涉及外后髁塌陷的胫骨平台骨折. 中华骨科杂志, 2022, 42(18): 1204-1211.
10.	焦竞, 肖飞, 黄玉成, 等. 3D打印结合胫骨外髁截骨治疗胫骨平台外后髁骨折. 中华骨科杂志, 2018, 38(15): 913-918.
11.	朱燕宾, 陈伟, 张奇, 等. 胫骨平台核心负重区的概念及其临床意义. 中华骨科杂志, 2021, 41(3): 137-140.
12.	Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
13.	Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg (Am), 1973, 55(7): 1331-1350.
14.	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-e23.
15.	Oeckenpöhler S, Domnick C, Raschke MJ, et al. A lateral fracture step-off of 2mm increases intra-articular pressure following tibial plateau fracture. Injury, 2022, 53(3): 1254-1259.
16.	Tarng YW, Lin KC. A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury. Injury, 2019, 50(10): 1756-1763.
17.	孔祥如, 杨春, 单宇宙, 等. 胫骨近端外侧锁定接骨板排筏螺钉联合Jail螺钉治疗胫骨平台外侧塌陷骨折. 中华创伤杂志, 2022, 38(6): 510-516.

1. Sohn HS, Yoon YC, Cho JW, et al. Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures. J Orthop Trauma, 2015, 29(2): 91-97.
2. Zhang Y, Song L, Li X, et al. Flexion-valgus unicondylar tibial plateau depression fracture pattern: Classification and treatment. Injury, 2018, 49(4): 852-859.
3. Sim JA, Park JH, Na YG, et al. Three-column subdivision for isolated posterolateral tibial plateau fractures and perspective surgical approaches. Knee, 2021, 33: 93-101.
4. Wang Y, Luo C, Zhu Y, et al. Updated three-column concept in surgical treatment for tibial plateau fractures-A prospective cohort study of 287 patients. Injury, 2016, 47(7): 1488-1496.
5. 汪国栋, 刘培钊, 刘曦明. 后外侧胫骨平台骨折手术入路之热点问题探讨. 创伤外科杂志, 2021, 23(10): 721-727.
6. Cho JW, Kim J, Cho WT, et al. Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures: a review with an emphasis on rim plating via modified anterolateral approach. Int Orthop, 2017, 41(9): 1887-1897.
7. 胡孙君, 杜守超, 李世杰, 等. 胫骨平台后外侧骨折的手术入路与内固定治疗技术的研究进展. 国际骨科学杂志, 2022, 43(1): 12-17.
8. 明安世, 汪洁, 朱登峰, 等. 选择性胫骨外髁U形截骨入路治疗胫骨外侧平台塌陷粉碎骨折. 中国骨伤, 2022, 35(6): 560-565.
9. 焦竞, 黄玉成, 肖飞, 等. 3D打印截骨导板结合 “栅栏” 螺钉技术治疗涉及外后髁塌陷的胫骨平台骨折. 中华骨科杂志, 2022, 42(18): 1204-1211.
10. 焦竞, 肖飞, 黄玉成, 等. 3D打印结合胫骨外髁截骨治疗胫骨平台外后髁骨折. 中华骨科杂志, 2018, 38(15): 913-918.
11. 朱燕宾, 陈伟, 张奇, 等. 胫骨平台核心负重区的概念及其临床意义. 中华骨科杂志, 2021, 41(3): 137-140.
12. Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
13. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg (Am), 1973, 55(7): 1331-1350.
14. 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-e23.
15. Oeckenpöhler S, Domnick C, Raschke MJ, et al. A lateral fracture step-off of 2mm increases intra-articular pressure following tibial plateau fracture. Injury, 2022, 53(3): 1254-1259.
16. Tarng YW, Lin KC. A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury. Injury, 2019, 50(10): 1756-1763.
17. 孔祥如, 杨春, 单宇宙, 等. 胫骨近端外侧锁定接骨板排筏螺钉联合Jail螺钉治疗胫骨平台外侧塌陷骨折. 中华创伤杂志, 2022, 38(6): 510-516.

Chinese Journal of Reparative and Reconstructive Surgery

Osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in treatment of tibial plateau fractures involving posterolateral column collapse

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