Surgical options for posterior tibial plateau fracture

Abstract

Objective: To investigate surgical methods and clinical effectiveness of posteromedial and posterolateral approaches for the posterior tibial plateau fracture.

Method: 21 cases who received surgery through posterior approaches for the treatment of posterior tibial plateau fractures (PTPFs) were included.

Results: 21 cases were subject to follow-up for 12-24 months (an average of 16.2 months). No cases developed incision inflammation, neurovascular injury, internal fixation loosening and breakage. All fractures were healed. No cases developed knee varus and valgus deformity and fracture dislocation. After surgery, Rasmussen score for knee joint functions was 13-30 points (a mean of 24.2). The results were excellent in 12 cases, good in 7 cases and fair in 2 cases. The percentage of excellent and good results was 90.5%. Rasmussen radiology score was 10-18 points (a mean of 15.6 points). The results were excellent in 13 cases, good in 7 cases and fair in 1 cases. The percentage of excellent and good results was 95.2%. 1 case had significant limited range of knee flexion and extension, which was improved after phase II release under arthroscopy combined with function exercise. 2 cases developed traumatic arthritis, which was relieved after intra-articular injection with sodium hyaluronate and oral nonsteroidal anti-inflammatory drug.

Conclusion: The posteromedial and posterolateral approaches for PTPF is good for reduction and fixation of PTPF. The approaches have benefits such as clear exposure, convenient placement of internal fixation, less trauma and good clinical outcome.

Keywords: Tibia; fracture; fracture fixation; internal; posterior approach.

Figure 1

Female patient, 24 years, had left posterolateral TPF due to fall, and underwent internal fixation with steel plate through posterolateral approach. A, B: A-P & lateral radiograph before surgery; C: Three-dimensional CT reconstruction before surgery indicated left posterolateral collapse TPF; D, E: A-P & lateral radiograph after surgery indicated good reduction of fracture; F: CT reconstruction at sagittal position after surgery indicated good reduction of collapse fracture.