Schatzker Type Ⅵ Tibial Plateau Fracture Combined With Proximal Fibular And Posterolateral Joint Facet Fracture On Early Postoperative Functional Recovery Of Clinical Research

Background and purpose: Tibial plateau fractures(TPFs)is a complex knee fracture that presents a bimodal trend in age,with two peaks in adolescents and older adults.With the development of transportation and the need of high-altitude work,the incidence of TPFs has increased.The force of the trauma that causes the fracture can be large or small.As the main bearing bone of the lower leg,the tibia has a poor prognosis for fractures involving the knee surface,which may adversely affect patients’ daily life and even lead to permanent deformity and disability.Most patients with TPFs choose surgical treatment,but there is no clear consensus among surgeons for different types.The proximal fibula and posterolateral joint facet(PJF)are important components of the knee joint that have received insufficient attention from surgeons,especially in patients with TPFs.The fibula is not directly involved in the formation of the knee joint,so it is often neglected in knee joint diseases.However,the anatomical structure of the proximal fibula and this area plays an important role in the coordination and normal function of the knee joint anatomy.Many bony trabeculae form the metaphyseal of the PJF of the tibia.The posterior medial reticular bone trabeculae of the fibular neck were more densely distributed.To provide stronger support for the fibula head.In addition,the arcuate complex forms a more stable articular connection between the tibiofibula.Thus,although the fibula is not directly involved in the formation of the knee joint,the fracture of the fibula may complicate the fracture of the tibial plateau.The objective of this study was to investigate the effect of proximal fibula and/or PJF fractures on early functional recovery after Schatzker type VI TPFs.Method: From November 2016 to February 2021,79 patients who ruled out into standard for Schatzker type VI fractures of tibial plateau accepted surgical treatment in our hospital.They were divided into three groups based on the integrity of the proximal fibular and PJF(Group A: 17 patients with intact proximal fibular and PJF;Group B: 21 patients with intact proximal fibular and PJF fracture;Group C: 41 patients with proximal fibular and PJF fractures).All procedures were performed by senior surgeons and each patient was followed up for at least 2 years.Details included demographics,time from injury to surgery,duration of surgery,length of hospital stay,preoperative and postoperative imaging follow-up,and complications.WOMAC score,HSS score,lateral knee pain,and lateral hamstring tightness were the results obtained at the final follow-up.HSS score and WOMAC score have high reliability in assessing knee function and osteoarthritis.Results: There was a significant difference in the HSS score between groups A and C(P<0.001)and between groups B and C(P=0.036).The number of days in the hospital was significantly different between groups A and C(P=0.038).There was a significant difference in lateral knee pain and lateral hamstring tightness between groups A and C(P<0.001)and between groups B and C(P<0.001).These findings indicate that postoperative knee function is significantly lower in patients with a proximal fibular fracture than in patients with an intact proximal fibular,increases the number of days in the hospital,lateral knee pain and lateral hamstring tightness.Conclusions: Proximal fibular and PJF fractures do not increase the time from injury to surgery,the incidence of complications,or the duration of surgery for Schatzker type VI TPFs.However,fractures of the proximal fibula significantly increase the hospital stay,reduce knee function,and cause lateral knee pain and lateral hamstring tightness.Combined proximal fibular fracture is more decisive than PFJ involvement for prognosis.