Tibial Plateau Posterior Column Fractures Treated Via Postero-medial Approach

Objective To discuss the utility and clinical efficacy of tibial plateau posterior column fractures treated by cutting off medial head gastrocnemius muscle via postero-medial approach.Methods 14 patients diagnosed as tibial plateau posterior column fractures had undergone surgical therapy via postero-medial approach from July,2013 to Spetember,2016 in the Department of orthopedics,The First Affiliated Hospital of Dalian Medical University.11 cases were male,3 casewas female,aging from 37 to 63,(50.4±9.6)on average.According to AO/OTA classification,6 cases were categorized into type 41-B3.3,3 cases to type41-C3.3,2 cases to type41-C3.13 cases to type41-B3.1,1 cases to type41-C1.2,1 cases to type41-C3.2 According to Three-column classification,posterior column were interfered in 2cases,both lateral and posterior column were interfered in 3 cases,both medial column and posterior column fracture were interfered in 4 cases and all three columns were interfered in 5 cases.Among the posterior column fracture:4 cases of simple medial posterior column fracture,medial posterior column split and lateral column collapse fracture in 10 cases.According to Schatzker classification,1 case were categorized into type II,6 cases were categorized into type?,4 cases were categorized into type V,3 cases were categorized into type VI.All patients were closed and fresh fractures.6 cases were caused by traffic injuries,2 cases caused by high falling,5 cases caused by slipped,and 1 case by fighting injury.Injury to surgery time from 2 to 12 days,(5.6±2.3)on average.And 7 cases treated by cutting off medial head gastrocnemius muscle via postero-medial approach were chosen as the observation group.Theother 7cases treated by not cutting offmedial head gastrocnemius muscle via postero-medial approach were chosen as the control group.According to the actual situation,autogenous ilium grafts or allograft-bone were used if necessary.In order to find out interrelationship bet,between the different path operation type and fracture healing,reduction effect,reduction stability and knee joint function.The fracture healing time,tibial plateau posterior slope angle and varus angulation,Rasmussen reset anatomy score,Hospital for Special Surgery(HSS)function scores of knee were statistically analyzed.Use the SPSS 19.0 statistical software to analysis all of the data.Results All post-operative incisions were healed in first stage.The lateral meniscus injury was found in 2 cases,the ending spot of posterior cruciated ligament was found rupture in two cases and an external dislocation of tibia were found combined with bone fragment incarcerated into lateral side of femoral condyle in one case.No important vascular and nerve injuries were found in all cases.All cases were followed up 8 to 12 months,mean(11.4±1.5)months.The clinical fracture healing time on average was 12 to 16 weeks,mean(14.7±1.3)weeks.No related complications occurred,such as articular surface depression,invalidity or rupture of internal fixators,infection,ankylosis,malunion,and traumatic osteoarthritis.There was no significant difference of fracture healing time between the observation group and the control group(P>0.05).A comparison concerning tibial plateau posterior slope and varus angle was made when drainage tube was removed after operation with the latest flollow-up after operation in the observation group and the control group,the difference was of no significance(P>0.05).There was no significant difference in Rasmussen reset anatomical score when drainage tube was removed after operation and Hospital for Special Surgery(HSS)knee function score the latest flollow-up after operation in two groups(P>0.05).Conclusion The feature of its anatomical position of Pes anserinus tendon and medial head gastrocnemius muscle makes it difficult to have a good exposure on the entire posterior anatomical structure for direct reduction and fixationvia traditional postero-medialapproach.This surgical therapy by Cutting off medial head gastrocnemius muscle via postero-medial approach not onlydoes not affect the time of fracture healing but also allows a good exposure on the entire posterior anatomical structure for direct reduction and fixation,which is suggested utility and effective in the treatment of tibial plateau posterior fracture.Besides,there were on more complications than the traditional one by Cutting off medial head gastrocnemius musclevia postero-medial approach.