No abstract

Background: The clinical effect of the three-incision combined approach for complex fracture of tibial plateau involving the posterior tibial plateau was discussed. Methods: A retrospective analysis was performed for 13 cases receiving surgery for complex fracture of tibial plateau from July 2015 to June 2019. They received surgery via the three-incision combined approach, and regular postoperative reexamination was performed at the outpatient clinic. During the last follow-up, Hospital for Special Surgery (HSS) Knee Scoring System was used to assess the knee joint function; the Lysholm score was used to assess the knee mobility. The anterior, posterior, and rotational stabilities of the knee joint were assessed by the Lachman test and pivot-shift test. Results: There was no nonunion and delayed union, implant loosening and fracture, or refracture, and neither were there neurological symptoms or restricted mobility in daily life. During the follow-up, none of the cases were found with restriction of knee mobility caused by internal fixation or apparent pain. The HSS score during the last followup was 86-100 (average, 90.2 ± 6.8), and the excellent and good rate was 100%; the Lysholm score was 86-100 (average, 95.7 ± 2.6). All cases were negative for the Lachman test and pivot-shift test. The knee flexion mobility was 100~140°(average, 127.2°± 11.4°). Postoperative X-ray indicated anatomical reduction of bone fractures in all cases. Loss of reduction or loosening and fracture of internal fixation was not observed by postoperative regular reexaminations. The posterior tibial slope at 6 months after surgery was 6~16°(average, 10.66 ± 2.58°), the varus angle was 84~89°(average, 86.52 ± 1.46°), the Rasmussen radiological score was 12~18 (average, 16.12 ± 1.35), and the excellent and good rate was 100%. Conclusion: The three-incision combined approach proved safe and reliable for complex fracture of tibial plateau involving the posterior tibial plateau and is worthy of further popularization.

BACKGROUND In most elderly patients with intertrochanteric fractures, satisfactory fracture reduction can be achieved by closed reduction using a traction table. However, intertrochanteric fractures cannot achieve satisfactory reduction in a few patients, which is called irreducible intertrochanteric fractures. Especially for type 31A3 irreducible intertrochanteric fractures, limited open reduction of the broken end with different intraoperative reduction methods is required to achieve satisfactory reduction and fixation. AIM To discuss clinical efficacy of intracortical screw insertion plus limited open reduction in type 31A3 irreducible intertrochanteric fractures in the elderly. METHODS A retrospective analysis was performed on 23 elderly patients with type 31A3 irreducible intertrochanteric fractures (12 males and 11 females, aged 65-89-years-old) who received treatment at the orthopedics department. After type 31A3 irreducible intertrochanteric fractures were confirmed by intraoperative C-arm, all of these cases received intracortical screw insertion plus limited open reduction in the broken end with intramedullary screw internal fixation. The basic information of surgery, reduction effects, and functional recovery scores of the hip joint were assessed. RESULTS All patients were followed up for 13.8 mo on average. The operation time was 53.8 ± 13.6 min (40-95 min). The intraoperative blood loss was 218.5 ± 28.6 mL (170-320 mL). The average number of intraoperative X-rays was 22.8 ± 4.6 (18-33). The average time to fracture union was 4.8 ± 0.7 mo. The reduction effect was assessed using Kim’s fracture reduction evaluation. Twenty cases achieved grade I fracture reduction and three cases grade II fracture reduction. All of them achieved excellent or good fracture reduction. Upon the last follow-up, the functional recovery scores score was 83.6 ± 9.8, which was not significantly different from the functional recovery scores score (84.8 ± 10.7) before the fracture ( t = 0.397, P = 0.694). CONCLUSION With careful preoperative preparation, intracortical screw insertion plus limited open reduction contributed to high-quality fracture reduction and fixation. Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.