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Archives of Orthopaedic and Trauma Surgery

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01-02-2015 | Trauma Surgery

Combined approaches for fixation of Schatzker type II tibial plateau fractures involving the posterolateral column: a prospective observational cohort study

Authors: Hui Sun, Qi-Lin Zhai, Ya-Feng Xu, Yu-Kai Wang, Cong-Feng Luo, Chang-Qing Zhang

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2015

Abstract

Introduction

This study aimed to investigate the surgical techniques and the clinical efficacy of combined approaches for the treatment of Schatzker type II tibial plateau fractures involving the posterolateral column [lateral and posterolateral columns (LPCs) fractures] in a prospective cohort.

Materials and methods

From January 2007 through December 2010, a total of 65 patients with LPCs underwent dual-plate fixation via a combined anterior and posterior approach. The anterior and posterior approaches were the conventional anterolateral approach and a posteromedial inverted L-shaped approach, respectively, with the patients in a floating position.

Results

Ultimately, 41 patients were followed up for a mean period of 52.5 months. All fractures healed. The mean time to radiographic bony union was 15.2 weeks and the mean time to full weight-bearing was 18.7 weeks. No parameter associated with knee alignment changed significantly between immediately postoperation and 2 years postoperation. No collapse of the reduced articular surface was detected. Two years postoperation, the mean Hospital for Special Surgery score was 92.3; the mean Short Form-36 score was 90.1, and the mean range of knee motion was 1.7°–123.6° (extension-flexion). Two patients suffered dehiscence of the anterolateral incision and another suffered partial necrosis at the margin of the posteromedial incision postoperatively. All healed in response conservative treatment. Another two patients experienced numbness in the posteromedial inferior region of the calf. No implant loosening, breakage, fixation failure, or other complication was observed during follow-up.

Conclusions

LPCs are not uncommon. Careful preoperative analysis of computed tomography images and impeccable preparation are necessary to avoid neglecting a posterolateral column fracture. It is inappropriate to generalize one scenario for all Schatzker type II fractures: a single approach cannot address all subtypes of these fractures. Dual-plate fixation via a combined approach is an effective treatment for LPCs.

Yang G, Zhai Q, Zhu Y, Sun H, Putnis S, Luo C (2013) The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system. Arch Orthop Trauma Surg 133(7):929–934PubMedCrossRef

Marsh JL (2010) Tibial plateau fractures. In: Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P (eds) Rockwood and Green’s fractures in adults, 7th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1792–1793

Luo CF, Sun H, Zhang B, Zeng BF (2010) Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 24(11):683–692PubMedCrossRef

Jiang R, Luo CF, Zeng BF (2008) Biomechanical evaluation of different fixation methods for fracture dislocation involving the proximal tibia. Clin Biomech (Bristol, Avon) 23(8):1059–1064CrossRef

Zeng ZM, Luo CF, Putnis S, Zeng BF (2011) Biomechanical analysis of posteromedial tibial plateau split fracture fixation. Knee 18(1):51–54PubMedCrossRef

Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zeng BF (2012) Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee 19(2):94–98PubMedCrossRef

Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscheme H (1997) Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg 100(12):957–967PubMedCrossRef

Carlson DA (2005) Posterior bicondylar tibial plateau fractures. J Orthop Trauma 19(2):73–78PubMedCrossRef

Tao J, Hang DH, Wang QG, Gao W, Zhu LB, Wu XF, Gao KD (2008) The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee 15(6):473–479PubMedCrossRef

10.

Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, Yu GR (2009) Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg 129(7):955–962PubMedCrossRef

11.

Solomon LB, Stevenson AW, Baird RP, Pohl AP (2010) Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationale. J Orthop Trauma 24(8):505–514PubMedCrossRef

12.

Frosch KH, Balcarek P, Walde T, Stürmer KM (2010) A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma 24(8):515–520PubMedCrossRef

13.

Chen HW, Liu GD, Ou S, Zhao GS, Pan J, Wu LJ (2014) Open reduction and internal fixation of postero-lateral tibial plateau fractures through fibula osteotomy-free postero-lateral approach. J Orthop Trauma 28(9):513–517PubMedCrossRef

14.

Sun H, Luo CF, Yang G, Shi HP, Zeng BF (2013) Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol 23(7):809–818PubMedCrossRef

15.

Oestern HJ, TTscheme H (1984) Pathophysiology and classification of soft tissue injuries associated with fractures. In: Tscherne H, Gotzen L (eds) Fractures with soft tissue injury. Springer, Berlin, pp 1–9CrossRef

16.

Zhai Q, Luo C, Zhu Y, Yao L, Hu C, Zeng B, Zhang C (2013) Morphological characteristics of split-depression fractures of the lateral tibial plateau (Schatzker type II): a computer-tomography-based study. Int Orthop 37(5):911–917PubMedCentralPubMedCrossRef

17.

Cross WW 3rd, Levy BA, Morgan JA, Armitage BM, Cole PA (2013) Periarticular raft constructs and fracture stability in split-depression tibial plateau fractures. Injury 44(6):796–801PubMedCrossRef

18.

Luo CF (2004) Reference axes for reconstruction of the knee. Knee 11(4):251–257PubMedCrossRef

19.

Wicky S, Blaser PF, Blanc CH, Leyvraz PF, Schnyder P, Meuli RA (2000) Comparison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures. Eur Radiol 10(8):1227–1232PubMedCrossRef

20.

Insall JN, Ranawat CS, Aglietti P, Shine J (1976) A comparison of four models of total knee replacement prostheses. J Bone Joint Surg Am 58(6):754–765PubMed

21.

https://www.optum.com/optum-outcomes/what-we-do/health-surveys/sf-36v2-health-survey.html. Accessed 14 Dec 2014

22.

Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L (2007) Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133PubMedCrossRef

23.

Zhu Y, Yang G, Luo CF, Smith WR, Hu CF, Gao H, Zhong B, Zeng BF (2012) Computed tomography-based Tree-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility. J Trauma Acute Care Surg 73(3):731–737PubMedCrossRef

24.

Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 138:94–104PubMed

25.

Yu GR, Xia J, Zhou JQ, Yang YF (2012) Low-energy fracture of posterolateral tibial plateau: treatment by a posterolateral prone approach. J Trauma Acute Care Surg 72(5):1416–1423PubMed

26.

Gossling HR, Peterson CA (1979) A new surgical approach in the treatment of depressed lateral condylar fractures of the tibia. Clin Orthop Relat Res 140:96–102PubMed

27.

Meng DP, Ye TW, Chen AM (2014) An osteotomy anterolateral approach for lateral tibial plateau fractures with relatively simple and intact posterolateral corner displacement. J Orthop Surg Res 15(9):26. doi:10.1186/1749-799X-9-26 CrossRef

28.

Bhattacharyya T, McCarty LP 3rd, Harris MB, Morrison SM, Wixted JJ, Vrahas MS, Smith RM (2005) The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma 19(5):305–310PubMed

29.

Brunner A, Honigmann P, Horisberger M, Babst R (2009) Open reduction and fixation of medial Moore type II fractures of the tibial plateau by a direct dorsal approach. Arch Orthop Trauma Surg 129(9):1233–1238PubMedCrossRef

30.

Huang YG, Chang SM (2012) The posterolateral approach for plating tibial plateau fractures: problems in secondary hardware removal. Arch Orthop Trauma Surg 132(5):733–734PubMedCrossRef

31.

Georgiadis GM (1994) Combined anterior and posterior approaches for complex tibial plateau fractures. J Bone Joint Surg Br 76(2):285–289PubMed

32.

Fakler JK, Ryzewicz M, Hartshorn C, Morgan SJ, Stahel PF, Smith WR (2007) Optimizing the management of Moore type I postero-medial split fracture dislocations of the tibial head: description of the Lobenhoffer approach. J Orthop Trauma 21(5):330–336PubMedCrossRef

33.

Weil YA, Gardner MJ, Boraiah S, Helfet DL, Lorich DG (2008) Posteromedial supine approach for reduction and fixation of medial and bicondylar tibial plateau fractures. J Orthop Trauma 22(5):357–362PubMedCrossRef

34.

Stahel PF, Smith WR, Morgan SJ (2008) Posteromedial fracture fragments of the tibial plateau: an unsolved problem? J Orthop Trauma 22(7):504–505PubMedCrossRef

35.

Chang SM, Wang X, Zhou JQ, Huang YG, Zhu XZ (2012) Posterior coronal plating of bicondylar tibial plateau fractures through posteromedial and anterolateral approaches in a healthy floating supine position. Orthopedics 35(7):583–588PubMedCrossRef

36.

He X, Ye P, Hu Y, Huang L, Zhang F, Liu G, Ruan Y, Luo C (2013) A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures. Arch Orthop Trauma Surg 133(1):23–28PubMedCrossRef

37.

Berber R, Lewis CP, Copas D, Forward DP, Moran CG (2014) Postero-medial approach for complex tibial plateau injuries with a postero-medial or postero-lateral shear fragment. Injury 45(4):757–765PubMedCrossRef

Title: Combined approaches for fixation of Schatzker type II tibial plateau fractures involving the posterolateral column: a prospective observational cohort study
Authors: Hui Sun
Qi-Lin Zhai
Ya-Feng Xu
Yu-Kai Wang
Cong-Feng Luo
Chang-Qing Zhang
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-014-2131-4

At a glance: The STEP trials

Springer Medicine

Combined approaches for fixation of Schatzker type II tibial plateau fractures involving the posterolateral column: a prospective observational cohort study

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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