Common Support Plate And Locking Plate For The Treatment Of Complex Comparative Efficacy Of Tibial Plateau Fractures

Objective: to investigate the efficacy of conventional support plate and lockingplate in treatment of complex tibial plateau fractures by a retrospective study.Methods:50knees of48patients with complex tibial plateau fractures treatedby conventional support plate and internal fixation with locking plate respectivelybetween May2005and May2012were retrospectively analyzed including22kneesby conventional support plate and28knees by internal fixation with locking plate.According to Schatzker classification,14knees were type IV,24knees type V,12knees type IV and two patients with fractures of double knees. Differences betweensuch indicators as mechanical stability, partial weight-bearing time of wounded limb,soft tissue complications, range of motion of knee, knee function (Rasmussen grading)of two treatment methods were compared.Results:50knees were followed up for average of14months (6.0to26.0months).1, in conventional plate group,2cases presented postoperativelow-toxic infections of soft tissue, oozing and delayed wound healing which washealed by dressing; in locking plate group,1case of proximal calf injury caused bydirect violence associated with partial tibial muscle necrosis, was healed by secondarydebridement without infection.2, in conventional plate group, Rasmussen score ofknee in6months after the operation was average22.5(17.0to28.0);range of motion of knees was average110.1degree (10.0to130.0degree). In lockingplate group, Rasmussen score of knee in6months after the operation was average24.9(19.0to29.0); range of motion of knees was average112.8degree (0.0-140.0degree). There was no significant difference between these indicators of two groups(P>0.05).3, in conventional plate group, partial weight-bearing time of woundedlimb was average6weeks (5.0-7.0weeks) after removing the stitches, in lockingplate group, the time was average5.4weeks (5.0-6.0weeks) after removing thestitches; there was significant difference between two groups (P <0.05).4, bothgroups of patients obtained bone healing in6months after the operation.Conclusion1, As for complex tibial plateau fractures, before surgery, high attention shall be paidto condition of soft tissue around the knee, fracture classification shall be defined andoperation plan shall be made (timing of surgery, approach, fixing method).2, Rigid fixation can be obtained with both plates, however, with comparison to theconventional plate the locking plate is mechanically more stable with less bone graftrequired, less soft tissue trauma and little postoperative discomfort, and isbeneficial for early functional exercise and partial weight-bearing.3, Use of locking plate fixation facilitates the minimally invasive operation, which isin line with the development trend of BO.