Pushing reduction via a pretibial bone tunnel for treatment of tibial plateau fracture / 中华创伤骨科杂志

ABSTRACT

Objective:To analyze the short-term efficacy of pushing reduction via a pretibial bone tunnel for treatment of tibial plateau fracture.Methods:From March 2019 to June 2019, 9 patients were treated at Trauma Emergency Center, Third Hospital of Hebei Medical University for tibial plateau fractures by pushing reduction through a pretibial bone tunnel. They were 7 males and 2 females, aged from 26 to 63 years (average, 38 years). Involved were 5 left sides and 4 right sides. According to the Schatzker classification, there were 7 cases of type Ⅱ and 2 ones of type Ⅲ. According to the Zhang's comprehensive classification of tibial fractures, they were all type Ⅰ. The patients were operated on under general anesthesia or intraspinal anesthesia. According to the length of fracture line, a circular drill was used to establish a bone tunnel which was 1 to 2 cm away from the distal fracture line. The collapsed fracture was reduced by the bar through the bone tunnel. A bicortical autogenous iliac bone or artificial bone bar was selected for bone grafting. The plate was placed through small incisions. Arthroscopic examination was used to measure the fracture displacement. The operation time, incision length, number of fluoroscopy, intraoperative blood loss and postoperative complications were recorded.Results:For the 9 patients, operation time ranged from 40 to 60 minutes (average, 48.3 minutes), intraoperative blood loss from 35 to 60 mL (average, 46.1 mL), number of fluoroscopy from 12 to 21 times (average, 17.4 times), length of reduction incision from 1.6 to 3.0 cm (average, 2.3 cm), fracture displacement after fixation from 0 to 2.0 mm (average, 0.8 mm), and maximum mobility of the knee joint from 125° to 140° (average, 128.9°) 15 days after operation. All incisions healed well by the first intention. Fibular vein thrombosis occurred in one case after operation. There were no infections or related complications.Conclusion:The short-term efficacy of pushing reduction through a pretibial bone tunnel for treatment of tibial plateau fracture is positive, but more reliable results should be waited for when much more surgical cases are available.