Anterolateral Locking Compression Plate Combined With Limited Internal Fixation Via Posteromedial Incision Versus Double Buttress Plate For Complicated Tibial Plateau Fractures

Objective To compare the imaging and clinical effects of the anterolateral locking compression plate combined with limited internal fixation via posteromedial incision versus double buttress plate for complicated tibial plateau fractures in the treatment of complicated tibial plateau fractures.Methods We retrospectively analyzed the clinical data of 62 patients with complicated tibial plateau fractures from January 2011 to January 2016.There were 35 men and 27 women,25 to 65 years of age(average,45.2years).By the Schatzker classification,25 cases were type ?and 37 type ?.According to different fixations,all patients were divided into two groups.Anterolateral locking compression plate combined with limited internal fixation via posteromedial incision group: locking compression plate fixation for anterolateral side,and distal radius "T" type plate or reconstruction plate for the posteromedial side of the tibial plateau.Double buttress plate group: both the anterolateral and posteromedial side were fixed with buttress plates.Surgical details and postoperative complications were recorded and compared between the two groups.Hospital for Special Surgery Knee Scoring System score was used to evaluate clinical outcome at the final follow-up.Results All of the 62 patients were followed up after operation,the time ranged from 13 to 25 months,with an average of 15.5 months.Both the two groups displayed satisfactory radiographic effects and clinical results.There were no significant differences in associated preoperative conditions between the two groups,it can be compared between the two groups.There was no statistically significant difference between the two groups in stability and HSS score.Compared with the double buttress plate group,length of operative incision was significantly shorter and bone graft required was significantly less in the anterolateral locking compression plate combined with limited internal fixation via posteromedial incision group,and the difference was statistically significant(P<0.05).It has demonstrated that the full weight-bearing time after operation was significantly earlier in the anterolateral locking compression plate combined with limited internal fixation via posteromedial incision group than in the double buttress plate group,and the difference was statistically significant(P<0.05).Compared with the double buttress plate group,the incidence of soft tissue complications of anterolateral locking compression plate combined with limited internal fixation via posteromedial incision group were lower,such as infection and flap necrosis,but there was no significant difference between the two groups(P>0.05).Conclusions 1.For complicated tibial plateau fractures,anterolateral locking compression plate combined with limited internal fixation via posteromedial incision and double buttress plate can both obtain well imaging and clinical effects,firmly fixation can be obtained with two groups;2.Compare to the double buttress plate the anterolateral locking compression plate combined with limited internal fixation via posteromedial incision is mechanically more stable with less soft tissue trauma,less bone graft required,and is beneficial for early functional exercise and full weight-bearing,which is in line with the development trend of BO.