Analysis of the efficacy of lateral collapsed bone fragments after medial incision reduction in the supine position in the treatment of Schatzker Ⅴ-type tibial plateau fractures
Objective To analyze the efficacy of lateral collapsed bone fragments after posterior lateral incision reduction and fixation in the supine position in the treatment of Schatzker Ⅴ-type tibial plat-eau fracture.Methods A retrospective analysis was performed for 31 patients with complex tibial plateau fracture with posterior lateral collapse from January 2018 to December 2021,including 19 males and 12 fe-males,the age range is between 21 and 69 years old,the mean age was 42.2 years,18 cases of left knee and 13 cases of right knee.The fractures were classified according to Schatzker and all were Ⅴ-shaped me-dial condylar fractures combined with posterolateral collapse,and CT examination was performed before surgery to clarify the direction of the fracture line of the medial tibial plateau,and it was clear that the frac-ture line passed through the posterolateral collapse fracture fragment of the tibia,and the lateral and poste-rior lateral walls were intact,and all of them were reduced by medial incision in the supine position,and the lateral collapse bone fragment,medial steel plate,and screw fixation were performed.Immediately after surgery,1 month,3 months,6 months and 1 year later,the anterior and lateral radiographs of the affected knee were routinely taken,the Tibial Plateau Varus Angle(TPA)and the Posterior Tibial Angle(PTS)were measured,and the Rasmussen imaging score was calculated to evaluate the reduction and reduction changes of the tibial plateau fracture,and the motor function of the affected knee was evaluated according to the knee joint score(HSS)standard of the New York Special Surgery Hospital one year after surgery.The TPA,PTS,and Rasmussen imaging scores of all patients were first tested to be in accordance with the nor-mal distribution,and then the paired t-test was used to match the data immediately after surgery and 1 year after surgery.The t-test was paired with the data of TPA,PTS and Rasmussen imaging scores of all patients immediately after surgery and the data of TPA,PTS and Rasmussen imaging scores of all patients 1 year af-ter surgery.Results Thirty-one patients were followed up for(14.8±1.7)months,the fracture healing time was(12.9±1.2)weeks,and the crutches began to fall to the ground 8 weeks after surgery,and the complete weight-bearing time was(13.9±1.3)weeks.Knee range of motion at the last follow-up:5 pa-tients had limited straightening,the degree of limitation was less than 10°,the average range of motion was(129.2±9.4)°,and there was no internal fixation failure and no knee instability in all cases.According to the Rasmussen imaging scoring system,the reduction of knee tibial plateau was evaluated as follows.Im-mediately after surgery:20 cases were excellent,9 cases were good,and 2 cases were acceptable,with an excellent rate of 93.5％(29/31).One year after surgery:19 cases were excellent,8 cases were good,and 4 cases were acceptable,with an excellent rate of 87.1％(27/31).One year after surgery HSS score:27 cases were excellent,2 cases were good,and 2 cases were acceptable,with an excellent rate of 90.3％(28/31).In the postoperative follow-up of 31 patients,there was little difference between the values of TPA immediately after surgery and TPA at 1 year after surgery(t=-1.345,P＞0.05).There was little difference between the values of PTS(lateral plateau)immediately postoperatively and PTS(lateral plat-eau)1 year after surgery(t=0.57,P＞0.05)was measured by t-test.The results showed that there was no significant difference,and the reduction was fixed and stable.Conclusion The treatment of Schatzker Ⅴ-type tibial plateau fracture with lateral collapsed bone fragments after medial incision reduction in supine position has a definite curative effect,and satisfactory results can be achieved by reducing the lateral col-lapsed bone fragments after medial incision and strong internal fixation,and the functional exercise as early as possible according to the fracture healing situation can reduce the occurrence of traumatic arthritis.
Knee jointMedial incisionTibial plateau fracturePosterolateral collapseFracture internal fixationSupine position
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