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Objective:To investigate the one-stage surgical treatment method and short-term therapeutic effect for combined anterior cruciate ligament (ACL) injury in Schatzker IV-VI tibial plateau fractures.Methods:A retrospective study was conducted on 79 patients with Schatzker IV-VI tibial plateau fractures who underwent surgical treatment at the Department of Traumatic Orthopedics in The Third Affiliated Hospital of Soochow University from April 2016 to February 2021 and there were 47 males and 32 females with a mean age of 51.5±13.2 years (ranging from 21 to 73 years old). Combined with preoperative MRI manifestations, meniscus injuries and avulsion fractures of collateral ligament complex were all repaired in one stage, primary reconstruction was not performed for the combined substantive injury of ACL body, and the displaced avulsion fracture of ACL insertion was only reduced without separate fixation during open reduction and internal fixation for fractures. Visual analogue scale (VAS), knee flexion range of motion, and American Hospital for Special Surgery Knee Joint (HSS) scores were used to evaluate the treatment outcomes at 3, 6, and 12 months postoperatively and the last follow-up.Results:All 79 patients successfully completed the surgery and were followed up for 23.6±2.2 months. The incidence of combined ACL injury was approximately 23% (18/79) with the main manifestation being intercondylar ridge avulsion fracture of ACL (10/18, 56%), which was more common in SchatzkerIV fractures (60%, 6/10). Postoperative KT-1000 measurements on the side-to-side difference in forward displacement of the healthy and affected knee joint showed no significant change in patients with ACL avulsion fracture and body injury, and there was no statistically significant difference compared to the normal range ( P>0.05). No statistically significant difference could be observed in postoperative VAS between ACL avulsion fracture, ACL body injury, and non-ACL injury groups ( P>0.05). At 3, 6, 12 months and the last follow-up after surgery, knee flexion range of motion in patients with intercondylar eminence avulsion fracture of ACL 99.7°±8.9°, 110.5°±10.3°, 120.9°±10.5°, and 121.5°±10.2° was lower than that in patients without ACL injury 106.5°±10.1°, 119.1°±9.8°, 128.3°±10.4°, and 128.3°±9.3°, and the differences were statistically significant ( P<0.05). At 3 and 6 months after surgery, patients with intercondylar eminence avulsion fracture of ACL had lower HSS scores 72.7±5.3 and 80.4±4.6 points compared to those without ACL injury 76.3±4.1 and 83.6±4.5 points, and the differences were statistically significant ( P<0.05). Conclusion:During the surgical treatment of Schatzker IV-VI tibial plateau fractures, it is feasible to treat possible concomitant injuries such as meniscus on the basis of reduction and fixation of the fracture without reconstructing the ACL in one stage, and to treat displaced ACL intercondylar eminence avulsion fractures by correct reduction without separate fixation. This treatment method can achieve good short-term postoperative outcomes.
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Objective:To investigate the specific types of lateral meniscus injury in Schatzker type II tibial plateau fractures and its potential correlation with CT features of the lateral plateau.Methods:The data of 213 patients with Schatzker II tibial plateau fractures from August 2014 to June 2021 were retrospectively analyzed, including 132 males and 81 females, aged from 29 to 61 years, with an average of 44.9 years. All patients underwent arthroscopic evaluation of fracture reduction immediately after open reduction and internal fixation (ORIF). According to the actual situation during the operation, the types and locations of lateral meniscus injury were determined and the patients were divided into the meniscus injury group and non-injury group. By measuring lateral plateau depression (LPD) and lateral plateau widening (LPW) of the lateral tibial plateau on CT images, the correlation of which and lateral meniscus injury was analyzed. The optimal critical values of LPD and LPW for predicting lateral meniscus injury were obtained by drawing the relevant receiver operating characteristic (ROC) curves.Results:The meniscus injury group (109 patients) mainly showed injuries involving the mid-body and posterior horn of lateral meniscus (98.2%, 107/109) and LPD was 13.1±3.2 mm; while the LPD of 104 patients without meniscus injury was 9.1±3.0 mm with a statistical difference ( t=3.98, P<0.001). The LPW of meniscus injury group and non-injury groups was 8.0±1.3 mm and 6.7±1.6 mm, respectively, and the difference was statistically significant ( t=2.68, P=0.011). The optimal predictive critical point of LPD and LPW was 7.6 mm (sensitivity 90.3%, specificity 64.7%, area under the curve 0.834) and 7.3 mm (sensitivity 80.5%, specificity 58.8%, area under the curve 0.722). Conclusion:Schatzker II tibial plateau fractures combined with lateral meniscus injury is usually characterized by meniscus-joint capsule separation, rupture and longitudinal fracture. The mid-body and posterior horn of lateral meniscus injury is more likely to occur when LPD> 7.6 mm and/or LPW> 7.3 mm on coronal CT images.
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Objective To compare the clinical outcomes between percutaneous minimally invasive suture versus conventional open suture for acute closed rupture of Achilles tendon.Methods A prospective study was performed in the 68 patients who had been treated for acute occlusive rupture of Achilles tendon from November 2010 to November 2013 at Department of Orthopedic Trauma, The Third Affiliated Hospital to Soochow University. They were randomly assigned by the sequence of medical attention to receive percutaneous minimally invasive suture or conventional open suture. In the conventional group, there were 31 men and 3 women with an average age of 37.0 ± 10.0 years; in the minimally invasive group, there were 30 men and 4 women with an average age of 36.4 ± 9.4 years. The 2 groups were compared in terms of operation time, intraoperative bleeding, postoperative wound infection, postoperative skin necrosis and ankle-hindfoot score of American Orthopaedic Foot and Ankle Society ( AOFAS ) . Results All the 68 cases were fol-lowed up for an average of 21.26 months ( from 6 to 36 months ). There were no significant differences between the 2 groups in operation time ( 75.0 ± 5.3 min versus 64.8 ± 3.8 min ) or in rate of postoperative local in-fection [ 2.9% ( 1/34 ) versus 14.7% ( 5/34 ) ] ( P ＞ 0.05 ). The minimally invasive group had significantly less intraoperative bleeding ( 12.0 mL ) , a significantly lower rate of skin necrosis [ 2.9% ( 1/34 ) ] and significantly higher AOFAS scores at 6 ( 90.5 ) , 12 ( 91.5 ) and 24 months ( 93.5 ) postoperatively than the conventional group did ( 80.0, 81.0 and 82.5, respectively ) ( all P ＜0.05 ). Conclusion Percuta-neous minimally invasive suture is recommendable for treatment of acute closed rupture of Achilles tendon because it leads to less intraoperative bleeding, better postoperative functional recovery and lower incidence of postoperative skin necrosis.