| Objective: The posterior condylar tibial plateau fractureis common and complex.It belongs to the tibial plateau fracture but differs from the general type. In normal conditions, the tibial plateau fracture line is sagittal, while the back condylar fracture line is usually coronal.Because of difficultly detected out by ordinary X-rays, it’s often misdiagnosed. As the medical science improving constantly, he CT and MRI are popular[1-2], it’s detected more and more by doctors. This fracture has been taken seriously in bone surgery because it is in the back of the keen joint which is crucial for the stability and its recovery directly affects the keen joint’s function.The aim of this review analysis were: to formulate the best therapeutic schedule on the base of clear definition for its characteristics, properties, positions, through out studying the two problems concerned by the orthopedists:(1) thefracture typing.(2) operative treatment.Methods: We selected the patients who were in the Third Hospital of Hebei Medical University from March 2012 to July 2014, whose fracture is in the tibial plateau back condylar, except the conservative treatment, intolerateing operative treatment, emergency operative treatment, lost to follow-up and so on. 62 patients were selected and divided into two groups according to the patients’ s clinical manifestation, physical examination, X-rays, CT, MRI and different operation plans, A: 29 patients whose operative incision were anteromedial or anterolateral. B: 33 patients whose operative incision were posteromedial combined with anterolateral or anteromedial. Then according to Chen[3]CT typing,there were: type I with posteromedial condylar tibial plateau split fracture 10(A:4,B:6); type II with posterolateral condylar tibial plateau split fracture 12(A:6,B:6); type III with posterolateral condylar tibial plateau depression fracture15(A:7,B:8), type IV with posterolateral condylar tibial plateau split depression fracture 16(A:7,B:9)and type V with posteromedial split and posterolateral condylar tibial plateau depression fracture9(A:5,B: 4).There were 9 patients combining the avulsion fracture of inter condylar spine & posterior condyle. By the chi-square test there was no statistically significant difference in two groups(P>0.05).All postoperative patients were follow-up surveyed in clinical and radiograph, measured their immediate and latest follow-up of tibial plateau varus Angle(TPA) and inner platform inclination Angle(PSA), They were all tested the keen joint activity after three months and follow-up end, and meanwhile in terms of the keen joint standard for evaluation of the Hospital for Special Surgery(HSS),all patients were given a mark.We put them as the curative effect standard,which were the operational time, amount of bleed, PTA, PSA, keen joint activity and HSS.SPSS was used to statistically analyse.Results: Themean follow-up period was 12.3 months(range: 8-14).(1) Typing Results: According to the results of preoperative examination and intra-operative exposure in patients, we divide the selected cases intoⅠ-Ⅴtypes by Chen CT classification. There are 9 patients with avulsion fractures of intercondyloid spine or medial back condyle. 5 cases of them are given the setting treatment and the other 4 cases are not given the setting treatment. We compare the follow-up visit of treated group with that of untreated group in the following three months. And the terminal HSS scores are as follows: 72.68±3.98, 60.50±5.20. The terminal HSS scores are: follow-up visit of group A and B are as follows: 109.83°±12.36°, 119.70°±11.25°(P<0.05). The HSS scores of group A and B in three months after the operation are as follows: 71.78±8.64, 78.31±7.15,(P<0.05). The HSS scores of postoperative follow-up visit of group A and B are as follows: 80.07±10.66, 86.66±7.83(P<0.05).According to terminal HSS scores of the patients, we divide group A and B into four grades: excellent, good, fair and bad(Excellent> 90 points; good 80-90points; fair 60-80 points; bad<60 points). There are 8 excellent cases, 13 good cases, 5 fair cases and 3 bad cases in group A. And there are12 excellent cases, 15 good cases, 5 fair cases and 1 bad case in group B. The result of treatment is excellent or good in 72.41% in group A, while 81.82% in group B.Conclusions: 1 We divide the selected cases intoⅠ-Ⅴtypes by Chen CT classification. The patients with avulsion fracture of tibial eminence are not included in the selected ones. The differences that are caused by giving patients setting treatment or not between the HSS scores of three-month follow-up visit and terminal HSS scores are of statistical significance. The writer is considering adding the VI type based on the Chen classification: hypocondyle & intercondyloid spine fractures and medial back condyleractures. 2 The back medial &anterior approach for treatment of posterior condylar tibial plateau fractures has many advantages, such as a small surgical injury, a relatively low degree of difficulty on surgery, a good postoperative recovery of knees, which is regarded as the ideal solution for the treatment of posterior condylar tibial plateau fractures. |
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