ObjectiveTo compare the biomechanical stability of acetabular transverse fracture fixed with single column locking reconstruction plate, locking reconstruction plate combined with lag screw, and double columns lag screws. MethodsAcetabular transverse fractures were established in 20 adult fresh semi-pelvis specimens, and divided into 5 groups randomly (n=4). The anterior columns were fixed with locking reconstruction plates in group A; the posterior columns were fixed with locking reconstruction plates in group B; the anterior columns were fixed with locking reconstruction plates and the posterior columns with lag screws in group C; the anterior columns were fixed with lag screws and the posterior columns with locking reconstruction plates in group D; the double columns were fixed with lag screws in group E. When loading three times weight, the longitudinal displacement of fracture fragment was measured, and the shear rigidity was calculated to compare the stability among groups. ResultsThe longitudinal displacement of groups A and B were significantly greater than that of groups C, D, and E (P<0.05), and the shear rigidity of groups A and B were significantly lower than that of groups C, D, and E (P<0.05). The longitudinal displacement of group B was significantly greater than that of group A (P<0.05), but no significant difference was found in the shear rigidity between groups A and B (P>0.05). There was no significant difference in the longitudinal displacement and shear rigidity among groups C, D, and E (P>0.05). ConclusionLocking reconstruction plate combined with lag screw and double columns lag screws have similar stability, they have stronger stability than the single column locking reconstruction plate. The stability of anterior column locking reconstruction plate is better than that of the posterior column locking reconstruction plate.
ObjectiveTo evaluate the effectiveness of the modified posterolateral counter-curved incision with double intermuscular approach for the treatment of posterolateral tibial plateau fractures. MethodsA retrospective analysis was made on the clinical data of 32 patients with posterolateral tibial plateau fractures between September 2012 and October 2014. There were 22 males and 10 females, aged 19 to 55 years (mean, 40.5 years). The causes of injury included traffic accident in 17 cases, falling from height in 9 cases, and falling in 6 cases. They had fresh closed fracture; injury to hospitalization time was 3 hours to 5 days (mean, 2 days). According to Schatzker tibial plateau fracture classification criteria, 20 cases were rated as type II, and 12 cases as type III. All patients underwent a modified posterolateral counter-curved incision with double intermuscular approach to expose tibial posterolateral condyle and anterolateral condyle. After a good visual control of fracture reduction, the anterolateral and posterolateral fractures were fixed with two-dimensional buttress plate respectively. ResultsThe incisions healed at stage I, with no major neurovascular injury. According to radiological assessment of the DeCoster score, the results were excellent in 21 cases, and fair in 11 cases. All of the 32 patients were followed up 18 to 30 months (mean, 20.5 months). The X-ray films showed that all patients obtained good fracture union, and the mean time of fracture union was 12.3 weeks (range, 10-16 weeks). No fixation failure or no obvious loss of articular surface reduction was observed during follow-up. The range of motion of the affected knees was 2-135° (mean, 120°). The mean American Hospital for Special Surgery (HSS) score was 90.05 (range, 83-96) at 18 months after operation. ConclusionThe modified posterolateral counter-curved incision with double intermuscular approach could fully expose posterolateral tibia plateau, and good fracture reduction and reliable fixation can be obtained under direct vision.