Expanded Anterolateral Approach For Tibial Plateau Fractures Involved The Posterolateral Column By Rafting Technique

Objective: To explore the short-term curative effect of expanded anterolateral approach in treating fracture involved the posterolateral tibial plateau through the rafting technique.Methods: A retrospective analysis was collected from the clinical data from 16 patients undergoing extended anterolateral approach for fracture involved the posterolateral tibial plateau between January 2013 and July 2016 was done.The patients were treated with 3.5 mm "L" type proximal tibial locking compression plate with the four locking screws through the rafting technique.The group consisted of 11 males(68.75%,11/16)and 5 females(31.25%,5/16),aged from 25 to 72 years old,mean(46.63±12.28);12 cases(75%,12/16)on the left and 4 cases(25%,4/16)on the right.According to Schatzker classification: ? 9 cases(56.25%,9/16),? type 6 cases(37.50%,6/16),? type 1 case(6.25%,1/16).According to Orthopedic Trauma Association(AO/OTA)classification: B type 9 cases(56.25%,9/16),all B3.1 type,C type 7 cases(43.75%,7/16),including C1.1 type 1 case(6.25%,1/16),C1.2 type 1 case(6.25%,1/16),C1.3 type 4 cases(25.00%,4/16),C2.2 type 1 case(6.25%,1/16).Results: X-ray was immediately performed after operation and it showed that 14 cases(87.50%,14/16)got anatomic reduction,2 cases(12.50%,2/16)left <2mm of steps.Rasmussen radiology score was 14 to 18 points,mean(17.00±1.46)points.X-ray examination showed on significant difference in TPA immediately after operation and 1.5,3,6,12 months later(F=0.051,P=0.985),and there was no significant difference in PA among the time points(F=0.023,P=0.995).At one-year of follow-up,the modified Rasmussen knee score ranged from 18 to 29 with an average of(25.00±3.33)points,of which 7 cases(43.75%,7/16)were excellent,8 cases(50.00%,8/16)were good and 1 cases(6.25%,1/16)was fair.The excellent end good rate was 93.75%.Knee range of motion was 110°-135° with a mean of(122.25±7.86)°.Lysholm score was(93.06±4.23).Evaluation of bohler sign and dial test were both negative.Conclusion: The short-term curative effect of expanded anterolateral approach in treating fracture involved the posterolateral tibial plateau with the 3.5mm L type proximal tibial locking compression plate proximal to the locking screw through the rafting technique is satisfactory,it provides sufficient exposure and effective fixation,the joint function end stability are satisfying.