Objective To explore the reduction and support effect of the subchondral screw compression technique for residual or secondary collapse of the lateral tibial plateau during operation. Methods Between January 2020 and June 2021, 11 patients with residual or secondary collapse of the lateral tibial plateau during operation were treated with the subchondral screw compression technique. There were 6 males and 5 females, aged 52.3 years old (range, 27-64 years). The fractures were caused by traffic accident in 10 cases and falling from height in 1 case and located at the left knee in 6 cases and the right knee in 5 cases. According to Schatzker classification, there were 5 cases of type Ⅱ fractures, 4 cases of type Ⅲ fractures, and 2 cases of type Ⅴfractures. According to the three columns classification, there were 5 cases of lateral column, 4 cases of lateral column and posterior column, and 2 cases of three columns. The time from injury to operation was 4.5 days (range, 3-7 days). During the follow-up, X-ray films were obtained and the Rasmussen standard was used to evaluate the quality of fracture reduction, meanwhile fracture healing was observed. The medial proximal tibial angle (mPTA), posterior tibial slope angle (pTSA), and articular surface collapse were measured at immediate and 12 months after operation. The knee joint range of motion was evaluated at last follow-up, and the knee joint function was evaluated using the Hospital for Special Surgery (HSS) score. Results All operations were successfully completed, with a mean operation time of 71.4 minutes (range, 55-120 minutes), and a mean hospital stay of 8.0 days (range, 5-13 days). The incisions all healed by first intention, without complications such as infection, flap necrosis, or vascular and nerve injury. All patients were followed up 16.5 months on average (range, 12-24 months). X-ray films showed that the fracture reduction score was 14-18 (mean, 16.7) according to Rasmussen score criteria; and 5 cases were rated as excellent and 6 as good. All fractures healed clinically with a mean clinical healing time of 14.9 weeks (range, 12-16 weeks), and there was no complications such as plate or screw loosening. At 12 months after operation, the mPTA and pTSA were (87.5±1.7)° and (6.2±3.1)°, respectively; there was no significant difference when compared to the values at immediate after operation [(87.6±1.8)° and (6.5±3.1)°] (P>0.05). The articular surface of the tibial plateaus was effectively supported, and it collapsed again by 0-1.0 mm at 12 months, with an average of 0.4 mm. At last follow-up, the knee joint range of motion was 115°-135° (mean, 126.8°) and the HSS score for knee joint function was 87-98 (mean, 93.9). Five patients underwent secondary operation to remove the internal fixator at 12-18 months after operation.ConclusionThe subchondral screw compression technique is helpful for the reduction of residual or secondary collapse of the lateral tibial plateau during operation, and can provide good support for osteochondral blocks.
Objective To observe the effectiveness of the superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau. Methods Between June 2010 and February 2012, 20 cases of posterolateral fracture of the tibial plateau were treated through superior fibular head approach, including 1 case of simple posterolateral fracture of the tibial plateau and 19 cases of posterolateral fracture of the tibial plateau with other fractures. There were 12 males and 8 females with an average age of 42.2 years (range, 28-58 years). All patients had closed fractures. Fracture was caused by traffic accident in 14 cases, by falling from height in 4 cases, and by twist injury in 2 cases. Associated injuries included lateral meniscus injury in 5 cases, medial meniscus injury in 2 cases, and anterior cruciate ligament injury in 1 case. The time from injury to admission ranged from 90 minutes to 32 hours (mean, 4.5 hours), and the time from admission to operation was 5-12 days (mean, 7.8 days). All cases underwent fracture reduction and fixation with Pilon plates through the superior fibular head approach, and associated fracture and meniscal injury were treated. Results All incisions healed by first intention, and no numbness or articular instability occurred. All patients were followed up 6-26 months (mean, 19.1 months). The average fracture healing time was 10.2 weeks (range, 8-12 weeks). During following-up, no related complication of fixation loosening or articular surface loss occurred. According to Rasmussen knee score criteria at last follow-up, the score was 18-30 (mean, 27.9); 16 cases were graded as excellent, 3 cases as good, and 1 case as fair, with an excellent and good rate of 95%. Conclusion The superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau is simple, safe, and effective, and can achieve a good surgical outcome.
Objective To evaluate the effectiveness and safety of minimally invasive treatment for bilateral tibial plateau fractures using the double reverse traction reducer. Methods The clinical data of 4 patients with bilateral tibial plateau fractures who met the selection criteria and treated between January 2016 and April 2024 were retrospectively analyzed. The cohort included 3 males and 1 female, aged 30-65 years (mean, 52.5 years). Injury mechanisms comprised traffic accidents (2 cases) and falls (2 cases). According to the Schatzker classification, 2 limbs were type Ⅱ and 6 were type Ⅵ. The time from injury to surgery ranged from 5 to 9 days (mean, 7 days). All patients underwent minimally invasive reduction using the double reverse traction reducer. Surgical duration, intraoperative blood loss, and hospitalization time were recorded. Functional outcomes were assessed at last follow-up using the Hospital for Special Surgery (HSS) knee score and range of motion (ROM), while fracture reduction quality was evaluated using the Rasmussen radiological score. Results All 4 patients successfully completed the procedure without conversion to open reduction. The total mean operation time was 80.25 minutes (range, 73-86 minutes), with a mean total intraoperative blood loss of 132.5 mL (range, 100-150 mL). The mean hospitalization time was 13.5 days (range, 11-16 days). All incisions healed primarily without neurovascular complications. X-ray film at 1 day after operation confirmed satisfactory reduction and articular surface alignment. Follow-up time ranged from 12 to 26 months (mean, 17.0 months). Fractures achieved clinical union at an average of 13 weeks (range, 12-16 weeks). No complication, such as deep vein thrombosis, joint stiffness, post-traumatic arthritis, or implant failure, was observed. At last follow-up, the mean HSS score was 92.9 (range, 90-97), mean knee ROM was 128.1° (range, 115°-135°), and mean Rasmussen radiological score was 16.4 (range, 15-19), with 2 limbs rated as excellent and 6 as good. Conclusion The double reverse traction reducer facilitates minimally invasive treatment of bilateral tibial plateau fractures with advantages including minimal trauma, shorter surgical duration, precise reduction, and fewer complications, effectively promoting fracture healing and functional recovery of the knee joint.
Objective To investigate the effectiveness of Allgöwer-Donati suture in open reduction and internal fixation of Schatzker type Ⅴ and Ⅵ tibial plateau closed fractures. Methods A clinical data of 60 patients with Schatzker type type Ⅴ and Ⅵ tibial plateau closed fractures, who met the selection criteria and admitted between May 2022 and May 2023, was retrospectively analyzed. After open reduction and internal fixation via double incisions, the incisions were closed with conventional mattress suture in 30 cases (control group) and Allgöwer-Donati suture in 30 cases (observation group). There was no significant difference in gender, age, fracture side and type, time from injury to operation, body mass index, and other baseline data between the two groups (P>0.05). The incidence of incision-related complications after operation, visual analogue scale (VAS) score of incision at 3 days and 1 and 2 weeks after operation, and the short-form 36 health survey scale (SF-36) [physical functioning (PF), role physical (RP), bodily pain (BP), and general health (GH)] at 12 weeks after operation were compared between the two groups. Results All operations of the two groups successfully completed. All patients were followed up 6-14 months (mean, 12 months). Incision fluid leakage occurred in 1 case of observation group and 7 cases of control group within 1 week after operation, and the incisions healed after symptomatic treatment. The incisions of other patients healed by first intention. The incidence of early incision complications in observation group was significantly lower than that in control group (P<0.05). No late incision complications was found in the two groups. There was no significant difference in VAS scores at each time point between the two groups (P>0.05). The VAS score significantly decreased with the increase of time in the two groups, showing significant differences between the different time points (P<0.05). There was no significant difference in SF-36 scores (PF, RP, BP, and GH) between the two groups at 12 weeks after operation (P>0.05). Conclusion Compared with conventional mattress suture, Allgöwer-Donati suture is effective in open reduction and internal fixation via double incisions for Schatzker type Ⅴand Ⅵ tibial plateau closed fractures, which can reduce the incidence of early incision complications.
ObjectiveTo explore effectiveness of reduction and internal fixation via modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column.MethodsBetween January 2016 and September 2018, 19 patients diagnosed as tibial plateau fractures involving posterolateral column were treated with reduction and internal fixation via modified anterolateral supra-fibular-head approach. There were 11 males and 8 females with an average age of 43.2 years (range, 28-65 years). The causes of tibial fracture were traffic accident (12 patients), falling injury (5 patients), and falling from height (2 patients). According to the Schatzker typing, the tibial fractures were rated as type Ⅱ in 9 cases, type Ⅲ in 4 cases, type Ⅴ in 4 cases, and type Ⅵ in 2 cases. The time from injury to operation was 5-13 days (mean, 8.5 days). There were 2 patients with osteoporosis. The operation time, intraoperative blood loss, and postoperative complications were recorded. The knee X-ray film was reviewed regularly to observe the fracture healing. At last follow-up, the fracture reductions were evaluated by Rasmussen radiological score. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score system.ResultsThe average operation time was 95 minutes (range, 65-130 minutes). The average intraoperative blood loss was 220 mL (range, 150-350 mL). All incisions healed by first intention. No complications such as infection or deep venous thrombosis occurred. All patients were followed up 12-20 months (mean, 15.4 months). X-ray films showed that the fractures healed with the healing time of 12-20 weeks (mean, 14.5 weeks). No complications such as loosening or breakage of internal fixation occurred. At last follow-up, according to the Rasmussen radiological score, the fracture reductions were evaluated as excellent in 13 cases, good in 4 cases, fair in 1 case, and poor in 1 case. HSS scores of knee joint function were excellent in 14 cases, good in 3 cases, fair in 1 case, and poor in 1 case. The knee joint range of motion was 90°-135°, with an average of 113.4°.ConclusionApplication of modified anterolateral supra-fibular-head approach in reduction and internal fixation for tibial plateau fractures involving posterolateral column has the advantages of full exposure, less trauma, safety, and reliable reduction and fixation.
Objective To explore the effectiveness of limited incision, poking reduction, and simple internal fixation in the treatment of collapsed fractures of the posterolateral tibial plateau. Methods Between October 2010 and January 2016, 16 patients with collapsed fractures of the posterolateral tibial plateau underwent posterolateral incision, poking reduction, and simple internal fixation. There were 10 males and 6 females with the age of 22-63 years (mean, 43.5 years). The injury was caused by falling in 5 cases, traffic accident in 7 cases, and falling from height in 4 cases. All cases had closed fractures. The left knee was involved in 9 cases and the right knee in 7 cases. The injury-to-admission time was 2 hours to 3 days (mean, 10 hours). X-ray films showed that the articular surface collapsing was more than 2 mm. According to Schatzker criteria, 6 cases were rated as type II and 10 cases as type III. Twelve cases had fracture of fibular head. The incision length, operation time, intraoperative blood loss, and incision healing were recorded; fracture healing was observed, and tibial plateau angle and posterior slope angle were measured on X-ray films; loss of articular surface reduction was observed by CT scan; and American Hospital for Special Surgery (HSS) score was used to evaluate the knee joint function. Results The incision length was 7-10 cm (mean, 8.6 cm); operation time was 35-55 minutes (mean, 46 minutes); intraoperative blood loss was 10-35 mL (mean, 28 mL). Primary healing of incision was obtained. Skin pain occurred in 1 case at 2 months because Kirschner wire retracted. Fifteen cases were followed up 8-21 months (mean, 13.5 months). The fracture healing time was from 3 to 6 months (mean, 4.8 months). There was no significant difference in tibial plateau angle and posterior slope angle between at immediate after operation and at last follow-up (t=–1.500, P=0.156; t=–1.781, P=0.097). The anatomic reduction rate of articular surface was 93.8% (15/16) at immediate after operation. At last follow-up, the recollapse height of articular surface was 0.1-1.2 mm (mean, 0.36 mm). According to the HSS score system, the results were excellent in 12 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 93.3%. Conclusion The limited incision by posterolateral approach, poking reduction, and simple internal fixation have the advantages of small injury, full exposure, and easy operation in the treatment of simple posterolateral tibial plateau fractures; bone graft support and simple internal fixation can prevent recollapse of the articular surface and achieve satisfactory knee function.
Objective To explore the treatment of the malunited fracture of the tibial plateau. Methods From June 2000 to June 2005, reconstruction was performed on 29 patients (18 males, 11 females; age, 1943 years, average, 31.6 years) with the malunited fracture of the tibial plateau. The injury duration ranged from 2.5 months to 2 years, averaged 9.7 months. After the injury, the plasterexternal fixation was performed on 8 patients and operation was performed on the other 21 patients. The operation was involved in the use of screws in 11 patients, anatomic plates, Golf plates and allotype plates in 8 patients, external fixation braces in 2 patients. A complicating injury to the anterior cruciate ligament (ACL) was found in 4 patients, an injury to the posterior cruciate ligament(PCL) in 2 patients, an injury to both ACL and PCL in 1 patient, and an injury to the meniscus in 6 patients. Reestablishment was performed on 19 patients, high tibial osteotomy on 7 patients, and osteotomy of the half tibial metaphysis on3 patients. Results Base on the followup for 8 months to 3 years(average, 13.6 months), the comprehensively scoring assessment showed that an excellent result was achieved in 8 patients, good in 15, fair in 4, and poor in 1, with an excellent and good rate of 82.1%, according to the Hohl knee joint function assessment on the pain, active movement, motion range, stability, and selfassessment. ConclusionFor the reconstruction of the malunited fracture of the tibial plateau, the satisfactory therapeutic effectiveness can only be achieved if the proper indications are identified and the suitable operative methods are adopted. The total knee replacement is only applicable to the elderly patient, and for the young patient, the reconstruction should be performed.
ObjectiveTo evaluate the effectiveness of reduction osteotomy for correction of varus knee during total knee arthroplasty. MethodsA retrospective analysis was made on the clinical data of 16 patients (24 knees) who received reduction osteotomy for correcting varus knee during total knee arthroplasty between May 2010 and July 2012. There were 2 males (3 knees) and 14 females (21 knees), with an average age of 67 years (range, 57-79 years). The disease duration ranged from 3 to 15 years (mean, 9.1 years). The Knee Society Score (KSS) was 38.71±10.04 for clinical score and 50.31±14.31 for functional score. The range of motion (ROM) of the knee was (91.88±13.01)°. The tibiofemoral angle was (9.04±4.53)° of varus deformity. Reduction osteotomy was applied to correct varus knee. ResultsThe operation time was 85-245 minutes (mean, 165.5 minutes); the obvious blood loss was 10-800 mL (mean, 183.1 mL); the hospitalization time was 8-22 days (mean, 13.6 days). All incisions healed by first intention. No neurovascular injury or patellar fracture occurred. The follow-up duration ranged from 37 to 62 months (mean, 48 months). The tibiofemoral angle was corrected to (3.92±1.89)° of valgus at 48 hours after operation. The lower limb alignment recovered to normal. The X-ray films showed no evidence of obvious radiolucent line, osteolysis, or prosthesis subsidence. The results of KSS were significantly improved to 84.21±6.49 for clinical score and 85.31±6.95 for functional score (t=20.665, P=0.000; t=9.585, P=0.000); and ROM of the knee was significantly increased to (105.83±11.29)° (t=8.333, P=0.000) at last follow-up. ConclusionThe effectiveness of reduction osteotomy for varus knee deformity during total knee arthroplasty is satisfactory. Proper alignment, ROM, and function of knee can be achieved.
Objective To investigate the evaluation, diagnosis, and surgical treatment of knee joint diagonal lesion and to observe its effectiveness. Methods A retrospective analysis was performed on 9 patients with knee joint diagonal lesion admitted between November 2011 and November 2019, including 7 males and 2 females, aged 18-61 years, with an average age of 38.3 years. According to the clinical staging criteria of multiple ligament injury of knee joint, 6 patients with acute stage injury (≤3 weeks), the time from injury to operation was 5-16 days, with an average of 9.3 days; 3 patients with old stage injury (>3 weeks), the time from injury to operation was 7, 12, 144 months, respectively. Posterolateral complex injuries were all type C according to Fanelli classification, and the posterior cruciate ligament injury was grade 3 according to American Medical Association (AMA) classification. According to the three columns classification of tibial plateau fracture, there were 2 cases of zero column fracture and 7 cases of medial column fracture. Patients with acute injury were treated with posterior cruciate ligament reconstruction, posterolateral complex repair and/or reinforcement reconstruction, and tibial plateau fracture was treated with conservative treatment or internal fixation. Patients with malunion of tibial plateau in old stage were treated with limited osteotomy, bone grafting, and internal fixation; the stability of the knee joint was further evaluated during operation, then the posterior cruciate ligament reconstruction and/or posterolateral complex repair and reconstruction were performed as needed. Lysholm score and the International Knee Documentation Committee (IKDC) score before and after operation were used to evaluate knee function and effectiveness. Results All patients were followed up 24-119 months, with an average of 51.7 months. All the incisions healed by first intention, and no complication such as incision infection, deep venous thrombosis of lower extremities occurred, and there was no reoperation during follow-up. The full-length X-ray films of both lower extremities at 6 months and 1, 2 years after operation showed that the alignment of both lower extremities returned to normal, and the stress position X-ray films showed that the stability in all directions recovered well. The X-ray films of the knee joint at 6 months after operation showed that the fracture of the tibial plateau healed well. At 1 year after operation, MRI showed that the signal of the repaired and reconstructed ligament was good, and there was no reconstruction failure such as ligament absorption or rupture occurred. At 1 year after operation, the muscle strength of the affected limbs was all rated as grade Ⅴ, and the active and passive range of motion of the knee joint recovered to 0°-130°. At 2 years after operation, the Lysholm score and IKDC score significantly improved when compared with those before operation (P<0.05). Conclusion Knee joint diagonal lesion is a special type of posterior cruciate ligament and posterolateral complex injury with anteromedial split and collapse fracture of tibial plateau, which requires correct evaluation and diagnosis of the injured structure, and detailed surgical and rehabilitation programs to achieve better effectiveness.
Objective To investigate short-term effectiveness of robot-assisted fracture reduction and fixation combined with arthroscopic exploration for posterolateral depressed tibial plateau fractures. Methods Between January 2022 and January 2024, 8 patients with posterolateral depressed tibial plateau fractures (Schatzker type Ⅲ) were treated using robot-assisted fracture reduction and fixation combined with arthroscopic exploration, with simultaneous treatment of concomitant ligament or meniscus tears. There were 3 males and 5 females with an average age of 54.1 years (range, 42-68 years). Injury mechanisms included traffic accidents (3 cases) and falls (5 cases). The time from injury to operation ranged from 2 to 4 days (mean, 3.1 days). Operation time, intraoperative blood loss, hospital stay duration, visual analogue scale (VAS) score for pain, and complications were recorded. Fracture healing and knee Rasmussen scores were assessed radiographically, while knee function was evaluated using range of motion and Hospital for Special Surgery (HSS) scores. Results All operations were successfully completed. The operation time was 108-129 minutes (mean, 120.1 minutes). The intraoperative blood loss was 10-100 mL (mean, 41.3 mL). The hospital stay duration was 4-7 days (mean, 5.6 days). All incisions healed by first intention without complication such as peroneal nerve injury, vascular damage, or infection. All patients were followed up 32-48 weeks (mean, 40 weeks). Radiographic follow-up confirmed that the knee Rasmussen scores rated as excellent in 8 patients and all fractures healed with the healing time of 12-16 weeks (mean, 13.5 weeks). The VAS score for pain was 2-4 (mean, 2.8) at discharge and improved to 0 at 1 month after operation. The knee range of motion was 80°-110° (mean, 96.1°) at discharge and increased to 135°-140° (mean, 137.9°) at 1 month after operation. At 3 months after operation, the HSS score was 91-94 (mean, 92.8), all graded as excellent. No severe complication, including implant failure, occurred during follow-up. Conclusion For posterolateral depressed tibial plateau fractures, the minimally invasive approach combining robot-assisted fracture reduction and fixation with arthroscopic exploration demonstrates multiple advantages, including shorter operation time, reduced intraoperative blood loss, excellent wound healing, fewer complications, and rapid recovery of knee function. This technique achieves satisfactory short-term effectiveness, while its long-term effectiveness requires further evaluation.