The Effect Of Fibula Neck Osteotomy And Carlson Posterolateral Approach In The Treatment Of Posterolateral Tibial Plateau Fractures

Objective To compare the clinical effect of fibular neck osteotomy and Carlson posterolateral approach in the treatment of posterolateral tibial plateau fractures,and provide reference for the selection of appropriate surgical approach for the treatment of posterolateral tibial plateau fractures.Methods Retrospective analysis of 62 patients with posterolateral tibial plateau fractures admitted to our hospital from March 2018 to October 2021,Among them,34 man,28 woman,27 left and 35 right,aged from 22 to 60 years old.The cause of injury was traffic accident in 41 cases,falling injury in 12 cases,and other injuries in 9cases.According to the different surgical approaches to the posterolateral tibial plateau fractures,they were divided into the fibular neck osteotomy group and the Carlson posterolateral surgical approach group.There were 36 cases in the fibular neck osteotomy group,including 21 men,15 women,17 left and 19 right,with an average age of 46.67 ± 10.59 years old,The cause of injury was traffic accident in 26 cases,falling injury in 6 cases,and other injuries in 4 cases.There were 26 cases of Carlson posterolateral surgical approach,including 13 male,13 female,10 left and 16 right.The average age was 43.85 ± 8.88 years old.There were 15 traffic accidents,6 fall injuries,and 5 other injuries.By comparing the operation time,intraoperative bleeding,fracture healing time,postoperative complications,Rasmussen radiation score at 12 months after operation,and HSS knee joint function score at 12 months after operation,we can understand the clinical effect of these two surgical approaches in the treatment of posterolateral tibial plateau fractures.Results All patients were effectively followed up for 12 months to 18 months,with an average of 14.7 months.During the follow-up period,no fracture,loosening or failure of internal fixation occurred in all patients,and all fractures were bony healed.In the fibular neck osteotomy group,the operation time was 90.75 ± 14.23 min,the intraoperative bleeding volume was 150.08 ± 15.50 ml,and the fracture healing time was 14.58 ± 1.83 weeks;In the Carlson posterolateral group,the operation time was84.81 ± 13.97 min,the intraoperative bleeding volume was 157.31 ± 13.62 ml,and the fracture healing time was 13.81 ± 1.23 weeks,Compared with the above data,the difference was not statistically significant(P>0.05)。The Rasmussen score of patients in the fibular neck osteotomy group was 17.56 ± 0.97 at 12 months after operation,and the HSS score was 86.42 ± 2.80 at 12 months after operation,The Rasmussen score of patients in the Carlson posterolateral group was 16.62 ± 1.26 points at 12 months after operation,and the HSS score at 12 months after operation was 84.88 ± 3.01 points.Comparison of the Rasmussen radiation score at 12 months after operation and the HSS knee joint function score at 12 months after operation between the two groups,The fibular neck osteotomy group was superior to the Carlson posterolateral group,The difference was statistically significant(P < 0.05);In terms of postoperative complications,there were 36 cases in the fibular neck osteotomy group,including 1case of skin infection,1 case of nerve injury,0 case of delayed fracture and malunion,and 2 cases in the fibular neck osteotomy group.There were 26 cases in the Carlson posterolateral surgical approach group,including 3 cases of skin infection,3 cases of nerve injury,1 case of delayed union of fracture,and 7 cases of postoperative complications in the Carlson posterolateral surgical approach group.The patients with skin infection were treated with sensitive antibiotics after culture of exudate and drug sensitivity test,and obtained primary healing after long-term dressing change;The patients with symptoms of nerve damage such as anterolateral hypoesthesia of the lower leg and foot ptosis were treated with nutritional nerve drugs for 2 months and completely recovered;The patients with delayed union of fracture were treated with brace fixation and immobilization for 9 months.The incidence of postoperative complications in the fibular neck osteotomy group and the Carlson posterolateral approach group were 5.56% and 26.92%,respectively.The incidence of complications in the fibular neck osteotomy group was lower than that in the Carlson posterolateral approach group,and the difference was statistically significant(P<0.05).Conclusion The results of this study show that both the fibular neck osteotomy approach and the Carlson posterolateral approach can treat the posterolateral fracture of the tibial plateau.However,in terms of the incidence of postoperative complications,the reduction of fractures and the recovery of knee joint function of patients after surgery,the fibular neck osteotomy approach has more significant clinical effect than the Carlson approach,which is worthy of clinical promotion.