ABSTRACT
Objective:To evaluate the outcomes of posterior-column dominating three-column tibial plateau fractures treated by raft-nailing and cannulated screwing via the posteromedian approach.Methods:From October 2017 to June 2019, 15 patients with posterior-column dominating three-column tibial plateau fracture were surgically treated at Department of Orthopedics, The First Affiliated Hospital to Harbin Medical University. They are 11 males and 4 females, aged from 26 to 65 years (average, 41.2 years). All patients were operated on under general anesthesia or spinal anesthesia. After full exposure via the posteromedian approach using a popliteal S-shaped incision, their fractures were treated with raft-nailing and cannulated screwing. Wound healing and neurovascular injury were observed after operation. X-ray films were taken regularly to monitor fracture union and measure the tibial plateau angle (TPA) and posterior slope angle (PA) of the tibial plateau. The knee function was assessed using The Hospital for Special Surgery (HSS) scoring system at 12 months after operation.Results:Incisions healed by the first intention after surgery in 14 patients but the healing was delayed due to fat liquefaction in one patient. No symptoms of neurovascular injury were observed in the 15 patients who were followed up for 12 to 29 months (average, 16.5 months). All fractures united after 12 to 20 weeks (average, 15.4 weeks). At 3 days and 12 months after operation, respectively, their PA was 9.3°±2.1° and 9.7°±1.6° and their TPA 4.3°±1.2° and 4.1°±1.1°, showing no significant difference ( P>0.05). At 12 months after operation, their HSS scores ranged from 84 to 95 (average, 89.3), their knee flexion from 105° to 138° (average, 126.5°) and their knee extension from 0° to 8° (average, 3.4°). Conclusions:In the treatment of posterior-column dominating three-column tibial plateau fractures, raft-nailing combined with cannulated screwing via the posteromedian approach can achieve not only full exposure by a single incision but also stable plateau fixation, reduce operative invasion, and simplify operative procedures, leading to fine surgical outcomes.
ABSTRACT
Objective To investigate the therapeutic efficacy of contralateral less invasive stabilization system (LISS) through a medial-posterior approach for fractures of femoral medial condyle.Methods From December 2010 to December 2014,14 patients with fracture of femoral medial condyle were treated surgically at our department.They were 10 males and 4 females,aged from 33 to 64 years (average,44.6 years).By AO classification,10 cases were type 33-B2 and 4 cases type 33-B3.Causes of injury included traffic accident in 7 cases,falling in 6 and heavy object crush in one.Internals from injury to operation ranged from 3 to 10 days (average,5.4 days).All the patients were treated by open reduction and internal fixation with contralateral LISS plate or T plate through a knee medial posterior approach.Results The 14 patients were followed up for 12 to 24 months (average,18 months).All fractures got bony healing after 3 to 5 months (average,3.5 months).No collapse of joint surface,joint stiffness,joint infection,malunion or nonunion occurred.According to the Schatzker-Lambert criteria for functional recovery of the distal femoral fractures,the function of the affected knee was assessed at the last follow-up as excellent in 9 cases,good in 3,fair in one and poor in one.Conclusion Open reduction and internal fixation with contralateral LISS plate through a medial-posterior approach is effective for fractures of femoral medial condyle due to its strong buttress,rigid fixation,advantage for early functional exercise,and satisfactory therapeutic outcome.