Surgical treatment of SchatzerⅣtibial plateau fractures through combined anterior and posterior approaches

TANG Fei; CHEN Rong-fu; XIAO Chao; WU Lei

doi:10.3969/j.issn.1009-4237.2016.08.015

Abstract：Objective To discuss the clinical outcomes of open reduction and internal fixation with the double plate via the posteromedial approach combined with anteromedial approach to treat complex Schatzker Ⅳtibi-al plateau fracture .Methods From Jan.2010 to Jun.2013,14 patients with posteromedial and medial columns fracture were treated with open reduction and dual plating fixation via the posteromedial and anteromedial approa -ches.There were 8 males and 6 females with an average age of 43 years(range,30 to 61 years).All fractures were fresh and closed .Sugeries were conducted via combined anterior and posterior approaches .Seperated and collapsed blocks were reducted and fixed with plates . Clinical effects and complications were observed .Results No skin necrosis,deep venous thrombosis ,neurovascular injury or wound infection occurred in this group .All were followed up for an average of 14.2 months(range,12 to 18 months).The mean radigraphic bony union time was (14.52 ± 2.07)weeks(range,12 to 18 weeks),and the mean full weight-bearing time was(17.32 ±2.41)weeks(range,13 to 20 weeks).The immediately postoperative Rasmussen score of all the patients was 16.12 ±1.04.The HSS score at 12 months postoperatively was 87.25 ±6.39.There was no significant difference in either the tibial plateau angle or posterior slope angle on radiographyics between immediately and 12 months after operation . During follow up , no screw or plate sliding ,dislodging or fixation failure was observed .Conclusion For tibial plateau fracture involving the medial column and posteromedial column simultaneously ,the posteromedial approach combined with anteromedi-al approach allows satisfactory reduction and fixation .It has many advantages such as good exposure ,earlier func-tional exercise ,and excellent clinical results .