Reduction via anterolateral condyle osteotomy or anterior tibial windowing in internal fixation of tibial plateau fractures with posterolateral condyle collapse
Objective To compare the reduction quality via anterolateral condyle osteotomy of the tibial plateau or anterior tibial windowing in the treatment of tibial plateau fractures with posterolateral condyle collapse Methods Data of 48 patients with tibial plateau fractures with posterior lateral column collapse treated by surgeries in the Department of Orthopedics,General Hospital of PLA Central Theater Command from Jan.2015 to Mar.2023 were retrospectively analyzed.There were 29 males and 19 females aged 22-69 (mean 41.6) years,with 14 road traffic injuries,9 falls from height,17 ground-level falls and 8 others.According to Schatzker classification,there were 31 cases of type Ⅴ and 17 type Ⅵ.Patients received different reduction approaches via anterolateral condyle osteotomy of the tibial plateau (osteotomy group,n=25) or anterior tibial bone windowing (windowing group,n=23).The amount of bone graft,operation time,fracture healing time and complications were recorded and compared.The collapse depth of the posterior lateral articular surface of the tibial plateau and the posterior sloping angle ( PSA) of the tibial plateau were evaluated and compared before,2 d and 6 months after surgery.The Rasmussen anatomical score was used to evaluate the reduction quality and the Hospital for Specialty Surgery ( HSS) score was used to evaluate the knee function.Results Patients were followed up for 6-24 (mean 16.2) months.Compared with the windowing group,the osteotomy group revealed significantly less amount of bone graft ( cm3,3.6±2.4 vs.5.3±2.0) and quicker fracture healing (week,13.9±1.8 vs.15.1±2.1,both P<0.05),but the operation time revealed no significant difference (min,153.4±19.2 vs.161.8±19.0,P>0.05).Preoperatively,the two groups were comparable in terms of collapse depth of the posterior lateral articular surface of the tibial plateau and PSA (both P>0.05),which were all significantly improved after surgery (all P<0.05 for two time-points compared with before surgery),moreover,intergroup comparison showed significantly better results in the osteotomy group at both postoperative 2 d (collapse depth:mm,0.7±0.1 vs.0.8±0.1;PSA:9.4°±1.5° vs.10.4°±1.5°) and 6 months (collapse depth:mm,1.0±0.1 vs.1.2±0.1;PSA:10.2°±1.9° vs.11.5°±1.7°;all P<0.05).The osteotomy group also showed much higher Rasmussen anatomical scores at postoperative 2 d (16.4±1.4 vs.15.4±1.6),6 month (15.7±1.4 vs.14.2±1.5) and last follow-up (16.0±1.1 vs.15.0±1.2),and much higher HSS score of the tibial plateau at 6 months (88.2±4.8 vs.84.2±6.1,all P<0.05 compared with the windowing group) .The incidence of complications revealed no statistically significant between the two groups.Conclusion Both reduction via anterolateral condyle osteotomy of the tibial plateau or window osteotomy of the anterior tibia are effective in the treatment of tibial plateau fractures with posterolateral condyle collapse.However,the former has the advantages of less bone graft,quicker fracture healing,better reduction of the articular surface,and superior long-term recovery of knee joint function.
万方数据
维普
