Locking compression plate fixation through a modified anterolateral approach for posterolateral tibial plateau fractures / 中华骨科杂志

ABSTRACT

Objective To investigate the clinical efficacy of locking compression plate fixation through a modified anterolateral approach for posterolateral tibial plateau fractures.Methods From June 2010 to March 2012,19 patients with posterolateral tibial plateau fractures underwent locking compression plate fixation through a modified anterolateral approach in our hospital.There were 11 males and 8 females,aged from 26 to 55 years (average,38.3 years).The injury causes included traffic accident in 10 cases,fall from height injury in 7 cases and falling injury in 2 cases.Two patients had avulsion fracture of the anterior cruciate ligament.The modified lateral S-shaped incision was adopted for all patients.All the patients underwent early and suitable rehabilitation after operation.The radiographic and clinical results were evaluated by using X-rays and the Rasmussen score,respectively.Results The average operative time was 95 minutes (range,80 to 120 minutes),and the average intraoperative blood loss was 180 ml (range,100 to 400 mi).All the patients were followed up for 12 to 24 months (average,16.2 months).Bone union was obtained in all patients,and the bony union time ranged from 8 to 14 weeks.There was no implant loosening/ breakage,bone nonunion,genu valgum,genu varum,redisplacement of fracture,and knee instability.Anatomic reduction was obtained in 18 patients.For one patient with posterolateral comminuted dislocation fracture,CT scan showed a step-off of 2 mm in joint surface after operation,and at final follow-up,the patient suffered from mild pain and the range of motion of the knee joint was 0 to 105 degree.The range of motion of the knee joint was 5 to 90 degree in one patient.The Rasmussen score ranged from 13 to 30 (average,22.9±4.9); the results were excellent in 10 cases,good in 7 cases and fair in 2 cases,and the excellent and good rate was 89.5％.Conclusion Locking compression plate fixation through a modified anterolateral approach is an effective method for posterolateral tibial plateau fractures,which has several advantages,such as simple and safe operation,stable fixation and less complications.