Reduction effect comparison of subarticluar fenestration and intraarticular osteotomy on lateral tibial plateau depressed fracture

FANG Yong-chao; HAN Kui-jing; YANG Li-xun; ZHANG Wen-dong

doi:10.3969/j.issn.2095-252X.2026.03.004

Abstract：Objective To compare the clinical effect of two reduction methods for lateral tibial plateau depressed fractures.Methods 78 cases of lateral tibial plateau depressed fractures surgically treated in Department of Orthopaedic Trauma,Norhern Jiangsu People's Hospital,from January 2019 to March 2024 were analyzed retrospectively.According reduction methods all patients were divided into fenestration group and osteotomy group.The general condition,perioperative period,follow-up and imaging measurement data were recorded and compared.Results There were 48 cases in fenestration group and 30 cases in osteotomy group,followed up for 13-71 months(mean 35.0±15.0 months).There were no significant differences in general condition and perioperative indexes between the two groups.There were no significant differences in fracture healing time and Rasmussen function score at each follow-up point between the two groups.2 cases of incision infection occurred in the fenestration group and 4 cases of joint stiffness occurred in the osteotomy group.Visual analogue scales(VAS)score of osteotomy group was higher than that of fenestration group at 3 months after operation(2.4±0.6 vs.2.0±0.7),range of motion(ROM)of knee joint extension and flexion in osteotomy group was significantly lower than that of fenestration group at 3 months after operation and at the last follow-up[(98.7±17.2)° vs.(112.1±10.6)°,(122.3±15.9)° vs.(130.0±9.1)°](P<0.05).The preoperative articular surface collapse degree in the osteotomy group was higher than that in the fenestration group[(12.0±5.0)mm vs.(8.6±4.7)mm],the preoperative Rasmussen imaging score in the osteotomy group was lower than that in the fenestration group(8.7±2.8 vs.11.7±2.7)(P<0.05).There was no significant difference in the articular surface collapse degree and Rasmussen imaging score between the two groups at different postoperative follow-up point.The increase of Rasmuussen imaging scores at the last follow-up in the osteotomy group was significantly higher than that in the fenestration group(7.5±3.7 vs.4.8±3.2)(P<0.05).Conclusions Both subarticular fenestration reduction and intraarticular osteotomy reduction can effectively reduce the depressed fracture of lateral tibial plateau.The pain is lighter and the range of motion is larger after fenestration reduction.Osteotomy group is more suitable for reduction of more severely depressed displacement fracture.