Causes Analysis And Countermeasures Of Failed Surgical Treatments In Tibial Plateau Fracture

Tibial plateau because of its anatomical and biomechanical characteristics, when directly or indirectly by the violence easily lead to fracture or collapse. So tibial plateau fracture is a common intra-articular fractures. At present along with increasing of the traffic accident and population aging, the tibial plateau fracture has become more common,which is about 1% in fracture. In severe cases, can also be combined meniscus or ligament injury, cause to serious obstacle of knee function. Most cases require surgical treatment. With the development of modern orthopedics, the treatment concept of tibial plateau fracture continuously updates, from staunch internal fixation to the biological fixeation, surgeons not only emphasize the treatment of fractures, also attention to the prtection and treatment of ligaments, meniscus and other organizations. Limited incision, direct or indirect reduction and biological fixeation are the surgical treatment direction of tibial plateau fractures now. But after operation some cases failed to meet the treatment standards,the height tibial plateau reduced, the stability and function of knee affected, knee ankylosis, knee turned inside and outside and other late complications maybe appeared.So many coplications seriously affected the patients'work and life,and brought a heavy psychological and financial burden to the patients and their families.The causes of failed surgery are variety,how to prevent the surgical failure is the most important problem that many surgeons should confront for now.This article aims to explore the cause of failure of the surgical treatment to tibial plateau fractures ,and in order to provide countermeasures. By retrieving Chinese Biomedical Literature Database (CBM), CNKI Chinese Journals Full-text, PUBMED and other professional database,the author collects a great deal of relevant literature,and combines clinical practice in our department, collects surgical cases of failure to do data retrospectively study, sums up and concluds the reasons of treatment failure on tibial plateau fracture,then discusses possible preventive and remedial measures,in order to make reference for clinical treatment.The conclusion: those causes of the failure in the treatment of tibial plateau fracture include:①Indications and surgical timing improper,②unsuitable choice of internal fixation and location,③improper operation,④no attention to soft tissue injury repair,⑤infection,⑥inappropriate postoperative functional exercise.Among the rest, unsuitable choice of internal fixation, location,and improper operation are the main reason that make the failure of surgery. Improper operation can divide into several aspects by surgery specific steps: Inappropriate choice of incision; Poor fracture reduction; no attaching importance to the Line of force restoration; Insufficient bone transplantation, inappropriate steel plate shaping,and so on. It should be prevention and treatment accordingly in clinic.In the treatment process,we should grasp the accurate adaptation disease of operation.,once many elements exist which cause joint instability such as articular surface is not flat or force of load line is skew, surgical treatment should be done. Strict grasp the timing of surgery, immediate surgical must be done if the patients were accompanied by an open wound or acute compartment syndrome or with vascular nerve injury, the remaining cases should improve the situation to be soft tissue first and then choose surgery time. Improve the preoperative imaging examinations and clinical examination, To avoid missing diagnosis and treatment of injury on meniscus, anterior cruciate ligament , lateral collateral ligaments and other soft tissues Make Accurate assessment of fracture type, select the appropriate fixation materials and pay attention to its location in the operation. Rational design surgical incision in order to minimize damage and relatively safe, revealing a clear, easy to cut as the best surgical approach. Engage for anatomic reduction of articular surface, as the operative priority.Meanwhile do emphasis on restoration of power lines, to avoid the knee become valgus deformity postsurgical. Master bone transplantation,and transplant sufficient amount of bone. Choose precise plastic plate. Prevent intraoperative and postoperative infection, and through a variety of measures to control and eliminate infection factors.Encourage patients to an early knee flexion to strengthen the activities of training, in order to avoid the occurrence of knee joint adhesion or stiffness. At the same time would like to emphasize weight-bearing late to prevent the fixation of fracture and collapse of articular surface again. in order to improve surgical treatment of tibial plateau fractures, Note that the above result is only a few poor results of operations and to be avoided,we should pay attention to the failure causes above and avoid them as much as possible.