Objective To investigate the efficacy of double-plating fixation via U-shaped incision in the treatment of type C3.3 distal femoral fractures. Methods From July 2006 to February 2009, 11 cases of type C3.3 distal femoral fractures were treated, including 5 open fractures and 6 closed fractures. Among them, there were 7 males and 4 females with an averageage of 43 years (range, 27-55 years). The locations were left side in 6 cases and right side in 5 cases. Fracture was caused by traffic accident in 8 cases and fall ing from height in 3 cases. The time from injury to hospital ization was 30 minutes to 7 days. After bone traction for 3 to 8 days, the operations were performed by double-plating fixation via U-shaped incision, and autograft of il iac bone or allogeneic bone grafting. Results The average time of operation was 128 minutes (range, 105-150 minutes). The average blood loss during operation was 344 mL (range, 290-380 mL). Shallow local skin flap necrosis occurred in 2 cases, and incision healed by first intention in others patients. All patients were followed up 22 months on average (range, 12-36 months). The bone union was achieved within 3-6 months (4.4 months on average). No implant loosening or refracture was found. According to Merchan et al criteria for knee joint function evaluation, the results were excellent in 4 cases, good in 5 cases, fair in 1 case, and poor in 1 case at last follow-up; the excellent and good rate was 81.8%. Conclusion The double-plating fixation via U-shaped incision has the advantages of better exposure, great convenience to manipulation, anatomical reduction, and rigid fixation. It provides an effective treatment for type C3.3 distal femoral fracture. However, its operation indications and operating instructions should be strictly followed.
Objective To evaluate the surgical treatment and its results of complex tibial plateau fractures.Methods From May 2003 to November 2004, 24 cases of complex tibial plateau fractures were treated by two-incision approaches. There were 16 males(including 1 case of bilateral), and8 females, with mean age of 40.6 years(21-65 years), eleven fractures occurred in left extremity and 14 in the right. No patients suffered open fractures. Fracture was caused by fall from height in 10 cases, by traffic accident in 12 cases and by another causes in 2 cases. According to Schatzkerclassification, type Ⅴ fracture was found in 14 extremities，type Ⅵ in 11 extremities. All cases were operated with twoincision approaches and double-plates fixation. The operation was performed 6-15 days after injury with mean 10.4 days. Results All cases were followed up from 12 to 23 months (mean 15.6 months). Time of the bone healing was 69 months, with mean 7.4 months. No reduction of anatomy was achieved because of comminuted fractures of articular surfaces in 2 limbs. The line of the lower extremity did not recover because of metaphysis comminution in 1 limb, which led to knee varus. Epidermal necrolysis was observed in 3 limbs, and the wound healedafter change dressing. The function of the knee wasevaluated according to Rasmussen’s criteria, the results were excellent in 10limbs, good in 8 limbs, fair in 3 limbs, and poor in 4 limbs. Conclusion The twoincision approaches reduced the complication of softtissueinjury, which is conductive to reduction of articular surface. Double-plates provide a sufficient internal fixation. It can permit early motion of knee joint. Therefore, two-incision approach are an effective surgical approach of treatment of complex tibial plateau fractures.