Comparison of extended anterolateral approach in treatment of simple/complex tibial plateau fracture with posterolateral tibial plateau fracture

Abstract

Background: Our hospital has recently used the extended anterolateral approach in posterolateral tibial plateau fracture. We compared the clinical effects of this method in Schatzker type II or type V/VI fractures with posterolateral tibial plateau fracture based on our patients.

Methods: The patients from January 2013 to December 2015 were summarized, and some of them were assisted with arthroscopy. According to Schatzker classification, patients with Schatzker type II fracture were divided into group A; patients with Schatzker type V/VI fracture were divided into group B. The fracture characteristics, operation statistics, and postoperative functional evaluation of each group were compared.

Results: A total of 46 patients were included in the study and were followed up for 23-45 months. There were 24 cases in group A and 22 cases in group B. The operation time and the amount of bleeding were significantly less in group A (P < 0.05). Twelve cases were assisted with arthroscopy including 6 patients in each group. The fracture healing time made no significant difference in the two groups (P > 0.05). All patients experienced no significant influence on daily life. The knee Rasmussen score was 26.8 in group A and 23.5 in group B (P > 0.05), and the knee range motion was 115.5° in group A and 106.6° in group B (P > 0.05). The excellent and good rate of reduction was 91.7% in group A and 81.8% in group B (P > 0.05), but the excellent rate of reduction was 83.3% in group A and 27.3% in group B (P < 0.05). The unfixed rate of posterolateral fracture was 16.7% in group A and 36.4% in group B (P > 0.05). One patient in group B suffered postoperative wound infection.

Conclusions: The extended anterolateral approach could obtain similar satisfactory clinical results in simple/complex tibial plateau fracture with posterolateral tibial plateau fracture. It seemed that easier operation, better posterolateral fracture reduction, and fixation occurred in relative simple fracture from our cases.

Trial registration: It was a retrospective study. This study was consistent with the ethical standards of the Second Affiliated Hospital of Zhejiang University Medical College and was approved by the hospital ethics committee and the trial registration number of our hospital was 20170053.

Keywords: Arthroscopy treatment; Extended anterolateral approach; Fracture reduction and fixation; Posterolateral tibial plateau fracture.

Fig. 1

The CT scan used to evaluate the posterolateral fracture fixation. a Cross CT scan showed screws fixation of posterolateral tibial plateau fracture, the arrow indicated posterolateral fracture was completely fixed, no free bone fragment; b Cross CT scan showed only part of the posterolateral fracture was fixed, the arrow indicated one bone fragment was free

Fig. 2

A case of type II tibial plateau fracture, female, 60 years old. a, b Preoperative X-ray showed lateral plateau fracture, increased width of the plateau, and posterolateral fracture. c, d Postoperative X-ray showed that the fracture was anatomically reduced and fixed by a lateral locking plate with rafting screws. e–g CT scan showed an anatomical reduction, and the arrow indicated the posterolateral fracture got satisfactory fixation by screws

Fig. 3

Findings during arthroscopy treatment. a The articular cartilage was broken and displaced before reduction. b The articular cartilage was reduced by open-window rod technique, and it was smooth