Observe The Clinical Effect And The Factors That May Influence The Functional After Open Reduction And Internal Fixation In Tibial Plateau Fractures

Background: The knee joint is the largest joint,and one of the most complex jointin our body.The stability of the anatomical structure is the assurance of the normalphysiological function.With the increase of traffic accident,falling injury, the tibialplateau fractures increasing. At present, the tibia plateau fracture is common clinicalfractures of lower limb, which account for about1%of the whole body fractures. Thishigh-energy trauma with large wound flat, often leads to the crush of the joint, and thestability of the knee joint is difficult to maintain. Tibial plateau fracture is intra-articularfracture, also known as tibial condyles fracture. Many of them with knee ligamentdamage and meniscus injury. Especially Schatzker type V~VI fractures, Inappropriatetreatment can lead to instability of knee joint, joint activity limitation, joint deformity,traumatic arthritis and other serious complications. Affect the normal life of thepostoperative patients. So treatment method has a great effect on postoperative functionrecovery of knee joint. With the development of orthopaedic technology level, thecognitive and concepts for treatment of tibial plateau fractures progress too. From thetraditional strong internal fixation to biology, we paid more attention to the repair ofligament and meniscus and soft tissue injuries. Traditional operation concept, wedemanded the anatomical reduction and strong internal fixation of the fracture toomuch. So, in operation we exposed widely,led to a variety of complications. Forcomminuted fracture of tibial plateau, open reduction and internal fixation can ensureanatomical reattachment articular surfaces and structure reconstruction, strong fixationallows the joint early functional recovery. The modified dual plating and less invasivestabilization system (LISS) are common used in clinical,and effectively reduced theincidence of soft tissue complications. The goal of the treatment is to gain a stable,balance and harmonious joint, ensuring painless range and capabilities of the joint. Atpresent,we have not reached a consensus and the understanding is not comprehensive enough about the factors that may influence the short-term functional outcomefollowing treatment, which affect not only our choice of mode of operation, but alsoaffect the set of postoperative rehabilitation training plan.Object：The first, to observe the results of the patients in our hospital that sustaineda tibial plateau fracture and were treatde with open reduction and internal fixation.Thesecondary purpose of this study was to find the factors that may influence the short-termfunctional outcome following treatment.Methods: Between March2008and January2012, there were94patients with atotal of96intra-articular proximal tibia fractures were treatde with open reduction andinternal fixation can be follow-up.Using the binary regression model for statisticalanalysis, to find the correlation between the functional outcome and demographicfactors including age,gender,smoking history,diabetes,Body Mass Index(BMI) or thefracture characteristic such as mechanism of the injury,initial plateau depression.,Schatzker classification..The functional outcome include the Rasmussen, complication,range of the motion,healing time and residual depression.Results: The94patients,at12months after surgery, mean range of the kneesmotion was126degress, the overall complication rate was13%,10%patients hadrequired the secondary surgery,and76%of the patiens had returned to their work.Wecontrol each demographic or fracture characteristic variable independently, we findthere were no significantly statistical correlation between age, gender, smoking history,diabetes, BMI, mechanism of the injury,initial plateau depression.,Schatzkerclassification and the functional outcome at the last follow-up.Conclusion: No individual factor can predicting the functional outcome at12months afer surgery.Although the articular step-off increased,the risk of plateau collapseincrease, neither step-off nor plateau collapse can predicting the functional outcome at12months postoperatively. That shows even have an imperfect radiographic results,thepatiens may have a good clinical results.