Review of the Efficacy of Open Reduction and Internal Fixation Combined with Non-Endoscopic Technique in the Treatment of Tibial Plateau Fracture Combined with Anterior Cruciate Ligament Intercondylar Ridge Fracture

Wang Hui; Wang Qiuyong; He Jiye; Cai Guiquan; Wang Dongliang; Xu Yan

Abstract：Objective To summarize the operation points and short-term curative effect of minimally invasive incision combined with open reduction and internal fixation in the treatment of tibial plateau fracture combined with anterior cruciate ligament intercondylar ridge fracture.Methods 25 patients[17 males,8 females,38 to 55 years old,mean age(45.74±5.63)years]with tibial plateau fracture complicated with avulsion fracture of anterior cruciate ligament insertion point treated in the Department of Orthopaedics of Shanghai Jiaotong University School of Medicine Affiliated Xinhua Hospital from January 2019 to January 2021 were selected as the research objects.The classification of tibial plateau fracture was Schatzker Ⅱ～Ⅴ.and the surgical classification of anterior cruciate ligament intercondylar ridge insertion fracture was Meyers McKeever Ⅱ～Ⅳ.Open reduction and internal fixation of tibial plateau with steel plate combined with medial longitudinal incision of patellar ligament were implemented in all operations.The anterior cruciate ligament and the fracture block at the insertion point of intercondylar crest were firmly fixed by suture technique combined with tunnel fixation technique.The incidence of postoperative adverse reactions was counted,and Lysholm score,International knee documentation committee,international knee documentation committee(IKDC)score,Tegner score and the hospital special surgery(HSS)score were used to comprehensively evaluate the knee function at the last follow-up.Results All patients underwent successful operation.After follow-up for 12 to 18 months,with an average of(14.5±2.1)months.The fractures were clinically healed.One patient had postoperative incision fat liquefaction,which was cured after debridement,dressing change and drainage,followed by second stage suture,and the wounds of other patients were healed in phase Ⅰ.One patient developed knee stiffness 2 months after operation,which was released manually under intravenous anesthesia,and the range of motion gradually returned to normal.Two patients developed traumatic arthritis of knee joint,and their symptoms improved after oral nonsteroidal anti-inflammatory drugs.At the last follow-up,all patients had knee straightening of 0 °,knee flexion of 100 ° to 135 °,with an average of(118.45±15.36)°.Lysholm score was(82.35±5.63).IKDC score was(85.67±6.44).Tegner score was(5.75±0.54).HSS score was(83.43±8.87),and it was excellent in 15 cases,dood in 7 cases,medium in 3 cases and poor in 0 case.The excellent and good rate was 88％.Conclusion For patients with tibial plateau fracture combined with anterior cruciate ligament intercondylar ridge fracture,open reduction and internal fixation combined with anterior patellar minimally invasive incision and non-microscopic line crossing tunnel technology can realize one-stage fixation of anterior cruciate ligament stop fracture block,which is conducive to early knee function rehabilitation exercise,early recovery of affected limb function and reduction of complications.