Clinical Results Of Modified Direct Postero-lateral Approach For Fixation Of Postero-lateral Tibial Plateau Fractures

Background:The tibial plateau is an important weight-bearing area of the body and plays a vital role in maintaining the function of the lower extremity.Fractures of the tibial plateau are relatively common in clinical work,and because the fracture involves the articular surface of the knee,anatomic repositioning is required.And posterior lateral tibial plateau fractures(PLF)are increasingly recognized as an important factor contributing to poor knee function after fracture surgery.For example,inadequate support of the posterior lateral plateau can lead to limited knee flexion function and even cause knee valgus deformity.Because of the deeper location of the posterior lateral plateau,the concealed nature of the fracture mass makes exposure of the operative field extremely difficult.It is also obstructed by the fibular head and lateral collateral ligament anteriorly,adjacent to the common peroneal nerve anterolaterally,and then immediately posteriorly to the popliteal artery,resulting in a narrow space available for manipulation.In addition,the operative field is also obscured by the tibial nerve,popliteal muscle,metatarsal muscle and gastrocnemius muscle,further increasing the difficulty of the operation.As a result,the incidence of inaccurate fracture reduction and fixation and incision-related complications is also higher.Currently,the selection of the appropriate surgical approach for these fractures is a hot issue at the forefront of clinical treatment.There is still no uniform conclusion on this.Objective:In this paper,we summarize in detail the diagnosis,staging,and treatment of PLF.Based on this,we modified the incision of the Carlson approach by replacing the S-shaped incision with a straight incision and preserving the popliteal muscle and the lateral infrapopliteal artery.We also explored the effectiveness of this method in fixing the posterior lateral bone block of the tibial plateau and preventing complications.Methods:Retrospective analysis of the Department of Traumatic Orthopedics Between September 2018 and March 2022,a total of 44 patients treated with PLF using the Carlson postero-lateral approach and modified direct postero-lateral approach were selected and divided into a control group and an observation group according to the surgical method.The postoperative nerve palsy,intraoperative bleeding,operative time,height of loss of tibial plateau collapse,active mobility,and the HSS score and Lysholm score of the knee at 12 months after surgery were compared between the control group and the observation group.The resulting data were tallied and statistically analyzed using SPSS software.Results:The amount of blood loss in the observation group was lower than that in the control group,and the difference was significant and statistically significant(P < 0.01);the operating time of patients in the observation group was significantly lower than that in the control group,and there was a statistical difference(P < 0.05);the knee flexion and extension function of patients in the observation group was lower than that in the control group 12 months after surgery,and there was a statistical difference(P < 0.05);the height of tibial plateau loss after surgery in the observation group was not significantly different than that in the control group(P > 0.05);the HSS scores as well as Lysholm scores of patients in the observation group were higher than those in the control group,and the differences were statistically significant(P < 0.05).Conclusion:Modified direct posterior lateral approach for PLF has less intraoperative bleeding,shorter operative time and fewer postoperative complications.It can effectively prevent postoperative loss and collapse of the tibial plateau articular surface and facilitate the recovery of the patient’s knee function.It has good surgical efficacy and deserves more use and research.