Modified Posterior Approach For The Treatment Of Posterior Tibial Plateau Fracture

Objective: To investigate the effect of modified posterior approach in the treatment of posterior tibial plateau fracture.Methods: From July 2011 to April 2014, 21 cases of posterior tibial plateau fracture were diagnosed and treated at the Second Affiliated Hospital of Dalian Medical University, including 17 cases of simple posterior fracture of the tibial plateau, 4 cases of posterior fracture of the tibial plateau with lateral column fracture or medial column fracture; There were 8 patients of postermedial tibial plateau fracture,5 patients of posterolateral tibial plateau fractures,4 patients involved with both posteromedial fracture and posterolateral fracture. There were 13 males and 8 females with an average age of 45.8 years(range, 39-55 years).Fracture was caused by tracaccident in 12 cases, by falling from height in 8 cases, by crushing injury in 1 case. All patients had closed fractures, some had skin injury by rubbed. The X-ray film, CT and 3D reconstruction examination of patients, if necessary, MRI examination,had been carried on before operation. According to the results of three-dimensional reconstruction with assessment of fracture,the doctors predesigned operation scheme and select the appropriate choice of internal fixation, the optimal operation timing, the modified posterior approach operation technique for the treatment of posterior tibial plateau fracture. In the operation process of exposure,the doctors had paid attention to the protection of the nerve, blood vessel, then reduced and fixed the fracture with the optimal internal fixation in the open case of tibial plateau fracture. There are some patients with ligament and meniscus injury. According to the degree of damage, less injury and suitable for the simultaneous operation treatment patients were treated with the first stage operation,serious damage patients were treated again when conditions permitted. There were 4 cases of posterior fracture of the tibial plateau with lateral column fracture or medial column fracture in this group, which cannot be reduced and fixed under the condition of single posterior approach and had to use the joint operation approach through the "floating" posture.After the operations, the patients were guided the recovery of knee joint function exercise and regular outpatient plain film, the doctors decided how to exercise and when weight-bearing exercise were decided by the doctors through the review of X-ray results).. The recovery process of knee joint function, the final clinical effect and Related complications were observed after operation, such as skin necrosis, ankylosis, traumatic osteoarthritis, and malunion.Results: All wounds achieved healing by first intention. No related complication occurred, such as delayed healing, skin necrosis, incision infection. X-ray showed that all patients was achieved reduction of anatomy immediately after operation. All patients were followed up 12-23 months(mean, 16.2 months). The patient began to partial weight-bearing exercise after 10~12 weeks. after fracture healing, the patients could do full weight-bearing exercise gradually. The average fracture healing period was 13 months(range, 12-15 months). No related complication occurred, such as nonunion, delayed union,failure in internal fixation, ankylosis, malunion, varus and valgus deformity. The average ROM(range of motion) of the affected knee joints was 5°-130°at 12 mouths postoperatively. The average HSS score was 87.2(range from 65-94,the rate of "excellent and good" was 90.5.Conclusion: Internal fixation through modified posterior approach for tibial plateau fracture has advantages of less surgery trauma, simple operation, fully exposed, fixed immobilization and received early postoperative rehabilitation. The clinical results are satisfied.