A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures

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Purpose This study was to evaluate clinical outcomes and complications following multi-plate reconstruction for treating severe bicondylar tibial plateau fractures of young adults. Methods Between September 2007 and February 2012, 26 patients with severe bicondylar tibial plateau fractures met inclusion criteria; they were treated using multi-plate technique through combined approaches. Patients received an average follow-up of 40.8 (range, 18-64) months, which included anteroposterior and lateral imaging, postoperative complications, range of motion and stability of the knee. The Rasmussen score was applied for functional and radiological evaluation. Results Three to five plates were used for reconstruction. No intra-operative complications occurred. Postoperative complications included bulge of hardware in four patients and superficial dehiscence in three cases in the anterolateral incision of which one developed to deep infection. There was no neurovascular damage, and no implant breakage or loosening. Hardware was removed partly or totally in 16 cases. The average Rasmussen score at final follow-up was 27.2 (range, 21-30) points for functional evaluation and 16.4 (range, 14-18) for radiology. Conclusions Multi-plate reconstruction is a valid and safe method for treating severe bicondylar tibial plateau fractures of young adults.

Section: Resultsmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Multi-plate reconstruction for severe bicondylar tibial plateau fractures of young adults

Zhai

Luo

2013

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“…A scrubbed assistant holds We first start from the posteromedial approach. An inverted L-shaped incision is made, centring the horizontal limb at the popliteal crease [4,7,14]. The medial arm of the incision is made just posterior to the medial edge of the tibia.…”

Section: Surgical Protocolmentioning

confidence: 99%

“…Chang et al [6,7] classified the tibial articular plateau into four-quadrants, and the fractures are categorized with an isolated single quadrant (anteromedial, anterolateral, posteromedial, and posterolateral) and different combinations of 2, 3 and 4 quadrants. The fracture on each quadrant may have unique characteristics [8][9][10][11][12] as well as require related incision or treatment protocols [13,14].…”

Section: Introductionmentioning

confidence: 99%

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Chang

Zhang

et al. 2014

Purpose Bicondylar tibial plateau fractures involving four articular quadrants are severe and complex injuries, and they remain a challenging problem in orthopaedic trauma. The aim of this study was to introduce a new treatment protocol with dual-incision and multi-plate fixation in the floating supine patient position as well as to report the preliminary clinical results. Methods From January 2006 to December 2011, 16 consecutive patients with closed bicondylar four-quadrant tibial plateau fractures (Schatzker type VI, OTA/AO 41C2/3) were treated with posteromedial inverted L-shaped and anterolateral incisions. With the posteromedial approach, three quadrants (posteromedial, anteromedial and posterolateral) can be exposed, reduced and fixed with multiple small antiglide plates and short screws in an enclosure pattern. With the anterolateral approach, after articular elevation and bone substitute grafting, a strong locking plate with long screws to the medial cortex is used to raft-buttress the reduced lateral plateau fracture, hold the entire reconstructed tibial condyles together, and contact the condyles with the tibial shaft. All patients were encouraged to exercise knee motion at an early stage. The outcome was evaluated clinically and radiologically after a minimum two-year follow-up. Results The average operation time was 98±26 minutes (range 70-128) and the average duration of hospitalization was 29±8.6 days (range 20-41). Three cases used five plates, nine cases used four plates, and four cases used three plates. All patients were followed for a mean of 28.7±6.1 months (range 26-38). Fifteen incisions healed initially, while one patient developed a medial wound dehiscence and was successfully managed by debridement. All patients achieved radiological fracture union after an average of 20.2 weeks. At the two-year follow up, the average knee range of motion (ROM) was 98°±13.7 (range 88-125°), with a Hospital for Special Surgery (HSS) knee score of 87.7±10.3 (range 75-95), and SMFA score of 21.3±8.6 (range 12-33). Conclusion For bicondylar four-quadrant tibial plateau fractures, the treatment protocol of multiple medial-posterior small plates combined with a lateral strong locking plate through dual incisions can provide stable fracture fixation to allow for early stage rehabilitation. Good clinical outcomes can be anticipated.

“…First, we made a posteromedial inverted L-shaped incision [4,5] on popliteal fossa, which went through the lateral side of semimembranous muscle, then we pulled the medial head of the gastrocnemius muscle to lateral side and then exposed the posterior column and the medial column. Next the fractures were treated by open reduction, bone grafting and temporary Kirschner pins fixation.…”

Section: Pre-operative Preparation and Surgical Techniquementioning

confidence: 99%

The application of a three-column internal fixation system with anatomical locking plates on comminuted fractures of the tibial plateau

Wang

Lin

et al. 2015