Study Of Surgical Treatment Of Tibial Plateau Posterior Condylar Fracture

Background:Fracture of tibia plateau is common intra-articular fracture,with a variety of classifications,and schatzker and AO classifications are used traditionally.Treatment of fracture of tibia plateau with medial and lateral approaches according to classifications are classic methods.Splitting fracture of posterior plateau is a special frature of tibia plateau,mainly affecting the posterior third of medial and lateral condyles of the tibia.With the application of CT scanning and three-dimentional reconstruction,more and more attention has been paid to the fracture.If not enough cognition has acquired about the fracture,improper treatment may be carried out,leading to unstable fixation and more complications.Aim:To study the surgical method and therapeutic effect of treatment of fracture of posterior tibia plateau with posterior approach of knee joint.Methods:From January 2014 to March 2015,15 patients(10 males and 5 females)with fracture of posterior tibia plateau were treated with posterior approach,aged 26-60 years old,and 41.2 years old in average.Reasons of injuries:8 car accident injuries,5 high falling injuries and 2 other injuries.The classification according to Luo Congfeng's three-column theory of tibia plateau:8 posteromedial fractures,2 posterolateral fractures and 3 combined posteromedical and posterolateral fractures.In the patients of fractures of posterior tibia plateau,3 patients were combined with fractures of medial or lateral condyles,2 patients were combined with fractures of attachment of posterior cruciate ligament and 2 patients were combined with fractures of fibula.Modified inverted-L approeaches of tibia plateau were applied,11 patients with posteromedial approaches,2 patients with posterolateral approaches,1 patient with anterolateral,posteromedial and posterolateral approaches,and 2 patients with anterolateral and posterolateral approaches.The patients were followed postoperation.In the period of follow-up,the patients were examined with X-ray to evaluate fracture healing,and Hohl scale was used to record the function of the knee joints in the end.Results:All 15 patients were followed for 4-20 months,and 12.1 months in average.In one of the patients,hematoma had formed under the incision,and the patient recovered after debridement,VSD drainage and stage II suture.No other incision complication had occurred.In all the cases,there were no neurovascular injury,internal fixation loosening and breakage.In all the cases,fracture healed,no loss of the articular surface height and angle of tibia plateau occurred and varus angle and caster angle were corrected.The Hohl function scales of the knee joint postoperation were 12-30,and 25.8 in average,and excellent for 9 cases,good for 5 cases,and middle for 1 case,with 93.3%were acceptable.The satisfaction rate of the patients were high.Conclusion:Buttress plate fixation with posterior approach is an effective method to treat fracture of posterior tibia plateau,with high clinical application value.The method has advantages like easy operation,slight injury,adequate exposure,easy to restore collapsed articular surface,safe and so on,with satisfying therapeutic effects and few complications.The method especially applies to the treatment of the complex fracture of unilateral and bilateral posterior column of tibia plateau.To master the method,we should be familiar with the anatomical structure of the popliteal fossa and correctly select the indications.