Observations of the Effects of Stepwise Superposition Reduction Method Using the Base Bone Fragments as a Standard Assisted with Open Reduc-tion and Internal Fixation on the Treatment of Traumatic Complex Tibial Plateau Fractures

ZHOU Jinjun; DENG Lin; WENG Deyu; WANG Meisheng; TAN Li; CHEN Jianjun

doi:10.3969/j.issn.1002-3429.2025.06.012

Abstract：Objective To investigate the effect of stepwise superposition reduction based on the basic bone fragments in the treatment of traumatic complex tibial plateau fractures with open reduction and internal fixation(ORIF)and its impact on joint function.Methods A total of 102 patients with traumatic complex tibial plateau fractures admitted from January 2019 to January 2024 were selected and divided into modified group(n=51)and conventional group according to the random num-ber table method(n=51).The conventional group underwent conventional ORIF,and the modified group underwent ORIF assisted by stepwise superposition reduction based on the basic bone fragments.The surgical indicators,fracture reduction quality[anatomical score of tibial condyle fracture reduction in Rasmussen radiological score],lower limb alignment[knee joint space width,tibial plateau collapse,lateral posterior angle(PA),tibial plateau angle(TPA),femorotibial angle(FTA)],knee joint function hospital for special surgery(HSS)score,and pain degree[visual analogue scale(VAS)],post-operative range of motion of knee joint and incidence of complications were compared between the two groups.Results The du-ration of operation,time to first ambulation,length of hospitalization and fracture healing time of the modified group were shor-ter than those of the conventional group(P＜0.01).The quality of fracture reduction in the modified group was better than that in the conventional group(P＜0.05).The knee joint space width,tibial plateau collapse,PA,and TPA in the modified group were lower than those in the conventional group at 3 d and 6 months after operation(P＜0.01).There was no signifi-cant difference in FTA between the two groups at 3 d and 6 months after operation(P＞0.05).At 3 and6 months after opera-tion,the HSS scores in modified group were higher than those in conventional group,and the VAS scores were lower than those in conventional group(P＜0.05).The maximum angle of knee extension and flexion in the modified group were higher than those in the conventional group at 1 week,3 months,and 6 months after operation(P＜0.05).The total incidence of complications in the modified group was lower than that in the conventional group(P＜0.05).Conclusion For complex traumatic tibial plateau fractures,the stepwise superposition reduction based on the basic bone fragments as the standard to as-sist ORIF can improve the quality of reduction,effectively relieve postoperative pain,and improve the alignment of lower limbs and knee joint function.