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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2018 | Research article

Comparison of extended anterolateral approach in treatment of simple/complex tibial plateau fracture with posterolateral tibial plateau fracture

Authors: Liangjun Jiang, Qiang Zheng, Zhijun Pan

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Abstract

Background

Our hospital has recently used the extended anterolateral approach in posterolateral tibial plateau fracture. We compared the clinical effects of this method in Schatzker type II or type V/VI fractures with posterolateral tibial plateau fracture based on our patients.

Methods

The patients from January 2013 to December 2015 were summarized, and some of them were assisted with arthroscopy. According to Schatzker classification, patients with Schatzker type II fracture were divided into group A; patients with Schatzker type V/VI fracture were divided into group B. The fracture characteristics, operation statistics, and postoperative functional evaluation of each group were compared.

Results

A total of 46 patients were included in the study and were followed up for 23–45 months. There were 24 cases in group A and 22 cases in group B. The operation time and the amount of bleeding were significantly less in group A (P < 0.05). Twelve cases were assisted with arthroscopy including 6 patients in each group. The fracture healing time made no significant difference in the two groups (P > 0.05). All patients experienced no significant influence on daily life. The knee Rasmussen score was 26.8 in group A and 23.5 in group B (P > 0.05), and the knee range motion was 115.5° in group A and 106.6° in group B (P > 0.05). The excellent and good rate of reduction was 91.7% in group A and 81.8% in group B (P > 0.05), but the excellent rate of reduction was 83.3% in group A and 27.3% in group B (P < 0.05). The unfixed rate of posterolateral fracture was 16.7% in group A and 36.4% in group B (P > 0.05). One patient in group B suffered postoperative wound infection.

Conclusions

The extended anterolateral approach could obtain similar satisfactory clinical results in simple/complex tibial plateau fracture with posterolateral tibial plateau fracture. It seemed that easier operation, better posterolateral fracture reduction, and fixation occurred in relative simple fracture from our cases.

Trial registration

It was a retrospective study. This study was consistent with the ethical standards of the Second Affiliated Hospital of Zhejiang University Medical College and was approved by the hospital ethics committee and the trial registration number of our hospital was 20170053.

Sohn HS, Yoon YC, Cho JW, Cho WT, Oh CW, Oh JK. Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures. J Orthop Trauma. 2015;29(2):91–7.CrossRef

Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010;24(11):683–92.CrossRef

Johnson EE, Timon S, Osuji C. Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures. Clin Orthop Relat Res. 2013;471(9):2760–7.CrossRef

Zhai Q, Luo C, Zhu Y, Yao L, Hu C, Zeng B, et al. Morphological characteristics of split-depression fractures of the lateral tibial plateau (Schatzker type II): a computer-tomography-based study. Int Orthop. 2013;37(5):911–7.CrossRef

Li Q, Zhang YQ, Chang SM. Posterolateral fragment characteristics in tibial plateau fractures. Int Orthop. 2014;38(3):681–2.CrossRef

He XF, Ye P, Hu Y, Huang L, Zhang F, Liu G, et al. A posterior inverted L-shaped approach for the treatment of posterior bi-condylar tibial plateau fractures. Arch Orthop Trauma Surg. 2013;133:23–8.CrossRef

Ozdemir G, Yilmaz B, Oztermeli A. Open reduction and internal fixation of the isolated tibial lateral plateau posterior fracture using direct posterior split gastrocnemius approach. Case Rep Surg. 2015;2015:530578.PubMedPubMedCentral

Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, et al. 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. 2009;129(7):955–62.CrossRef

Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscheme H. Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg. 1997;100(12):957–67.CrossRef

10.

Yu B, Han K, Zhan C, Zhang C, Ma H, Su J. Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee. 2010;17(5):313–8.CrossRef

11.

Frosch KH, Balcarek P, Walde T, Stürmer KM. A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma. 2010;24(8):515–20.CrossRef

12.

Kfuri M, Schatzker J, Castiglia MT, Giordano V, Fogagnolo F, Stannard JP. Extended anterolateral approach for complex lateral tibial plateau fractures. J Knee Surg. 2017;30(3):204–11.CrossRef

13.

Egol KA, Cantlon M, Fisher N, Broder K, Reisgo A. Percutaneous repair of a Schatzker III tibial plateau fracture assisted by arthroscopy. J Orthop Trauma. 2017;31Suppl 3:S12–3.CrossRef

14.

Chen XZ, Liu CG, Chen Y, Wang LQ, Zhu QZ, Lin P. Arthroscopy-assisted surgery for tibial plateau fractures. Arthroscopy. 2015;31(1):143–53.CrossRef

15.

Luo C, Wang Y, Zhu Y, Zhai Q, Zhan Y, Qiu W, et al. Updated three-column concept in surgical treatment for tibial plateau fractures-prospective cohort study of 287 patients. Injury. 2016;47(7):1488–96.CrossRef

16.

Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am. 1973;55(7):1331–50.CrossRef

17.

Biggi F, Di Fabio S, D’Antimo C, Trevisani S. Tibial plateau fractures: internal fixation with locking plates and the MIPO technique. Injury. 2010;41(11):1178–82.CrossRef

18.

Manidakis N, Dosani A, Dimitriou R, Stengel D, Matthews S, Giannoudis P. Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 125 cases. Int Orthop. 2010;34(4):565–70.CrossRef

19.

Bhattacharyya T, McCarty LP 3rd, Harris MB, Morrison SM, Wixted JJ, Vrahas MS, et al. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma. 2005;19(5):305–10.PubMed

20.

Tao J, Hang DH, Wang QG, Gao W, Zhu LB, Wu XF, et al. The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee. 2008;15(6):473–9.CrossRef

21.

Sun H, Zhai QL, Xu YF, Wang YK, Luo CF, Zhang CQ. Combined approaches for fixation of Schatzker type II tibial plateau fractures involving the posterolateral column: a prospective observational cohort study. Arch Orthop Trauma Surg. 2015;135(2):209–21.CrossRef

22.

Zhang P, Lian K, Luo D, Huang Z, Li T, Lin D. A combined approach for the treatment of lateral and posterolateral tibial plateau fractures. Injury. 2016;47(10):2326–30.CrossRef

23.

Ruiz-Ibán MÁ, Diaz-Heredia J, Elías-Martín E, Moros-Marco S, Cebreiro Martinez Del Val I. Repair of meniscal tears associated with tibial plateau fractures: a review of 15 cases. Am J Sports Med. 2012;40(10):2289–95.CrossRef

24.

Sassoon AA, Torchia ME, Cross WW, Cass JR, Sems SA. Fibular shaft allograft support of posterior joint depression in tibial plateau fractures. J Orthop Trauma. 2014;28(7):e169–75.CrossRef

25.

Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN. Complications after tibia plateau fracture surgery. Injury. 2006;37(6):475–84.CrossRef

26.

Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zeng BF. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee. 2012;19(2):94–8.CrossRef

27.

Sun H, Zhu Y, He QF, Shu LY, Zhang W, Chai YM. Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau: the magic screw technique. Injury. 2017;48(12):2814–26.CrossRef

28.

Hu SJ, Chang SM, Zhang YQ, Ma Z, Du SC, Zhang K. The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures: a novel surgical technique. Injury. 2016;47(2):502–7.CrossRef

Title: Comparison of extended anterolateral approach in treatment of simple/complex tibial plateau fracture with posterolateral tibial plateau fracture
Authors: Liangjun Jiang
Qiang Zheng
Zhijun Pan
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-018-1007-7

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Comparison of extended anterolateral approach in treatment of simple/complex tibial plateau fracture with posterolateral tibial plateau fracture

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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