Surgical Technique of Anterolateral Approach for Tibial Plateau Fracture

A 66‐year‐old woman had sustained crush injury 3 hours prior to her presentation to our hospital. The diagnosis was defined as lateral tibial plateau fracture of the right knee (Schatzker III). Supine position was set up and a pad was put under the affected hip. After sterilization of the surgical field the sterilized sheets were placed beneath the leg in order to be higher than the other side. A rolled sheet was put under the knee joint so that the knee joint was flexed around 30° to 40°. After the surgical field was draped the skin was incised. Iliotibial band was incised by blade (not by electrotomy) and sharp dissection was performed in the Gerdy's tubercle. Capsulotomy was made by cutting the tibial meniscal ligament. Then the meniscus was tagged superiorly and the articular surface was clearly visualized. A window was made in the lateral cortex beneath the plateau, so the impacted fragment was elevated through the window. The metaphyseal void was filled by bone allograft. The placement of the raft‐screw plate must be ensured that the raft screws passing the plate could purchase the subchondral bone. After perfect placement of the plate was defined, the femoral distractor was removed and the knee joint was relaxed. It was ensured that the alignment of the lower leg was normal, and then the other screws were inserted. Following placing drainage in the wound the iliotibial band was closed and the subcutaneous soft tissue and skin were closed in layer.     

Surgical Treatment of Tibial Plateau Fractures

Objective

Closed reduction of Schatzker type 4, 5, and 6 fractures of the tibial plateau, internal fixation by lag screws inserted through a mini-incision, and stabilization with Ilizarov external ring fixator.

Indications

Fractures of the tibial plateau of Schatzker type 4, 5, and 6.

Contraindications

Open infected tibial plateau fractures. Relative contraindications are Schatzker type 1, 2, and 3 fractures of the tibial plateau which can be treated by simpler methods.

Surgical Technique

Reduction of fracture by longitudinal traction on a frature table. Percutaneous insertion of two or three 6.5-mm lag screws to compress the major fragments. Stabilization of the fracture with a three-ring construction of the Ilizarov frame. Further compression of fragments with olive wires, used also to reduce and compress posterolateral and/or posteromedial fragments. The frame is ex-tended to the femur in instances of subluxation of the knee joint, ligamentous injuries, and associated femoral condylar fractures.

Results

Between 1991–1997, 56 patients were operated on. Aver-age follow-up: 3 years. Union occurred in all. Six patients showed a varus deformity of 5–10° and one a varus deformity of 15° four patients had an extension lag between 5–10°. A minor pin tract infection was observed 20 times and a major pin tract infection three times necessitating pin removal. One patient who suffered a compound fracture complicated by aseptic arthritis eventually required an arthrodesis. Applying the score of the American Knee Society, an excellent result was obtained 20 times, a good result 28 times, a fair one four times, and a poor one four times.     

胫骨平台陈旧性骨折及骨折后畸形愈合的手术治疗

目的探讨陈旧性胫骨平台骨折及骨折后畸形愈合的治疗方法。方法陈旧性胫骨平台骨折37例(男31例,女6例),从受伤或第一次手术至本次手术时间平均28.5个月(1个月～6年)。34例行截骨、软骨面抬高、植骨和内固定术;3例同时行自体骨软骨移植术。结果平均随访62.3个月,骨折全部愈合;膝关节屈曲角度比健侧平均减少(15.7±7.5)°;疗效按Merchant评分,优20例,良14例,可3例,优良率91.9%。结论应综合患者的年龄、病情考虑手术方案;依靠胫骨的解剖形态X线检查具有诊断可靠、方便的优点;对手术难度要有充分的认识。     

Surgical Strategy for Anterior Tibial Plateau Fractures in Hyperextension Knee Injuries

ObjectiveThe aim of the present study was to summarize the clinical characteristics, treatment strategies, and clinical results for anterior tibial plateau fractures caused by hyperextension injuries.MethodsWe performed a retrospective analysis of 26 cases of anterior tibial plateau fractures that were treated with open reduction and internal fixation from January 2016 to December 2019, including 16 men and 10 women, aged 26–68 years old, with an average age of 47 ± 12.5 years. According to the three‐column theory classification, there were 16 cases of single‐column fractures (9 cases of anteromedial fractures and 7 cases of anterolateral fractures), 3 cases of two‐column fractures (anteromedial + anterolateral fractures), and 7 cases of three‐column fractures. Options for the surgical approach included anteromedial, anterolateral, modified anterior median, and anterolateral + posteromedial incision. The implants included a T‐shaped plate, an L‐shaped plate, a horizontal plate, and a TomoFix plate. The surgical approach and fixation method were selected based on the characteristics of the anterior tibial fracture. The Rasmussen radiological criteria were used to evaluate the effects of fracture reduction and fixation. The knee joint function was evaluated using the knee function evaluation criteria of the Hospital for Special Surgery. Medial and lateral stress tests, the Lachman test, and the pivot shift test were used to evaluate the stability of the knee joint. The range of knee motion was recorded.ResultsAll cases were followed up for 12–24 months, with an average follow up of 15.7 months. The operation time was (148 ± 42) min; the intraoperative blood loss was (150 ± 50) mL. A total of 22 cases were anatomically reduced and 4 cases were well‐reduced, and the compression reduction rate was 100%. According to the Rasmussen radiology scoring, 17 cases were excellent and 9 cases were good. The excellent and good rate was 100%. The fracture healing time was 3.3 months. There is no difference in fracture healing time for different fracture types. Both the Lachman and pivot shift test findings were normal in 24 patients and nearly normal in 2 patients. The posterior drawer test was normal in 25 patients and close to normal in 1 patient. The varus stress test was normal in 24 patients and nearly normal in 2 patients, while the valgus stress test was normal in 23 patients, nearly normal in 2 patients, and abnormal in 1 patient. The range of motion (ROM) was 100°–137°, with an average of 125° ± 11.7°. The Hospital for Special Surgery (HSS) knee score at the last follow up was 79–98 points, with an average of 87.54 ± 8.36 points; the results were excellent in 21 cases and good in 5 cases. Therefore, 100% of results were excellent or good. Two cases had superficial wound infections after the operation. The recovery of 2 patients with common peroneal nerve injury was poor.ConclusionThe appropriate surgical approach and fixation method were performed according to the different positions of the anterior tibial fracture and satisfactory results were obtained after surgery.     

关节镜辅助下内外联合双钢板内固定治疗复杂胫骨平台骨折

目的探讨关节镜辅助下内外侧联合入路双钢板内固定治疗复杂胫骨平台骨折的临床效果。方法复杂胫骨平台骨折42例,其中SchatzkerⅣ型3例,Ⅴ型27例,Ⅵ型12例,均采用内外联合入路,关节镜协助操作及检查关节面的复位情况,同时治疗半月板损伤14例及交叉韧带损伤13例。充分植骨以支持关节面的复位。内固定方法：内侧采用小T型或重建锁定钢板,外侧采用加压或锁定高尔夫型钢板。结果 41例伤口一期愈合,1例切口皮肤软组织坏死行皮瓣修复后愈合。本组42例经平均2.6（0.5～4）年随访,骨折愈合时间平均5（3～19）个月。按Lysholm膝关节功能评分标准,优35例,良4例,中3例,优良率92.9%。所有病例无膝关节内外翻畸形,仅有3例（7.1%）术后有轻度的关节面再次塌陷。结论关节镜辅助下内外双侧钢板内固定治疗复杂胫骨平台骨折是简单有效的办法,内固定稳定,术后可进行早期功能锻炼,疗效确切,并发症少。     

复杂胫骨平台骨折的手术治疗

目的　探讨复杂胫骨平台骨折的治疗方法。方法　自 1993年 1月～ 1999年 6月收治复杂胫骨平台骨折 5 9例 ,均经切开复位、“AO”T型支撑钢板内固定。结果　随访 1年～ 5年 ,共 47例 ,优良率 89 36 %。结论　复杂胫骨平台骨折应当考虑手术治疗。MRI检查有助于全面评价骨折区域的整体情况 ;必须早期处理受损的软组织 ;在手术中 ,压缩的骨折块应整块上抬复位 ,而钢板与螺钉的置入方法相当重要 ,其它稳定结构应予修复并于术后早期作功能训练     

关节镜下微创治疗胫骨平台骨折探讨

目的探讨关节镜技术在SchatzkerⅠ~Ⅳ型胫骨平台骨折治疗中的应用价值。方法对23例SchatzkerⅠ~Ⅳ型胫骨平台骨折患者在关节镜监护下行复位螺钉内固定术,镜下同时处理关节内合并损伤。结果术后随访5~17个月,8.3月后所有骨折均获骨性愈合,无感染、皮肤坏死及创口延迟愈合。按HSS评分标准:优18例,良3例,可2例,优良率91.3%。结论关节镜监护下治疗胫骨平台骨折损伤小,操作安全,复位固定满意,能同时处理关节内合并伤,术后功能恢复快。     

胫骨平台骨折的治疗和术后并发症的预防

目的:总结胫骨平台骨折手术治疗的临床结果,分析术后并发症极其相关因素,提出有效的预防措施。方法:回顾性分析本院1996年1月～2000年6月收治的98例胫骨平台骨折手术患者,骨折类型按Schatzker分型,其中Ⅰ型14例、Ⅱ型25例、Ⅲ型16例、Ⅳ型9例、Ⅴ型12例、Ⅵ型22例。除Ⅰ型骨折采用空心螺钉固定外,其它各型采用开放复位,钢板螺钉内固定,缺损处自体骨植骨。对手术后并发症及其发生的相关因素进行分析。结果:98例获得随访,平均随访时间3.6(2～5)年,功能评价采用Hohl膝关节功能分级系统,临床结果优良率达到86.7％。术后发生各种并发症22例,其中创伤性关节炎12例,关节强直4例,关节不稳6例。结论:手术内固定是治疗胫骨平台骨折的有效方法,术后并发症的发生与术前并发症及骨折的严重度密切相关,术中骨折的解剖复位,恰当的内固定,正确处理术前并发症和术后早期、适当的功能锻炼是预防术后并发症的有效措施。     

胫骨平台骨折合并胫骨近端粉碎性骨折的手术治疗

目的总结胫骨平台骨折合并胫骨近端粉碎性骨折手术治疗效果。方法对55例胫骨平台骨折合并胫骨近端骨折患者行胫骨平台和近端骨折复位,钢板内固定。结果55例平均随访1.5年,均获得骨性愈合,时间3~15个月。膝关节功能完全恢复20例,屈伸轻度受限26例,7例屈伸范围<60,°2例因过早负重致膝外翻畸形,行二期截骨髂骨植骨术后功能恢复。结论胫骨平台骨折并胫骨近端粉碎性骨折应用解剖钢板能进行可靠固定,并具有支撑作用,能使骨折的复位与固定达到要求。     

胫骨平台骨折的治疗和术后并发症的预防

目的：总结胫骨平台骨折手术治疗的临床结果，分析术后并发症极其相关因素，提出有效的预防措施。方法：回顾性分析本院1996年1月～2000年6月收治的98例胫骨平台骨折手术患者，骨折类型按Sehatzker分型，其中Ⅰ型14例、Ⅱ型25例、Ⅲ型16例、Ⅳ型9例、V型12例、Ⅵ型22例。除Ⅰ型骨折采用空心螺钉固定外，其它各型采用开放复位，钢板螺钉内固定，缺损处自体骨植骨。对手术后并发症及其发生的相关因素进行分析。结果：98例获得随访，平均随访时间3．6(2～5)年，功能评价采用Hohl膝关节功能分级系统，临床结果优良率达到86．7％。术后发生各种并发症22例，其中创伤性关节炎12例，关节强直4例，关节不稳6例。结论：手术内固定是治疗胫骨平台骨折的有效方法，术后并发症的发生与术前并发症及骨折的严重度密切相关，术中骨折的解剖复位，恰当的内固定，正确处理术前并发症和术后早期、适当的功能锻炼是预防术后并发症的有效措施。     

Tibial Plateau Fractures: Evaluation and Treatment

The goal of tibial plateau fracture management is a stable, well-aligned, congruent joint, with a painless range of motion and function. Minimally displaced stable fractures should be treated with protected mobilization. The treatment of displaced tibial plateau fractures, however, remains controversial. Surgical reduction and stabilization of displaced tibial plateau fractures, when indicated, requires careful evaluation of both the "personality" of the fracture and the soft-tissue envelope. The timing of surgery and the handling of the soft tissue in this region are critical to treatment success. After restoration of a congruent joint surface, bone grafting and buttress plating are usually needed to allow early range of motion and optimize treatment outcome.