Objective To explore the clinical efficacy of lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating for simple posterolateral tibial plateau fractures.Methods From January 2014 to February 2017,11 patients with simple posterolateral tibial plateau fracture were treated at Department of Orthopaedics,General Hospital of Middle Military Command of PLA.They were 8 males and 3 females,aged from 21 to 55 years (average 41.8 years).In all of them the supra-fibular-head approach was used for lateral osteotomy according to the size and orientation of the fracture block.After the fracture was reset,a full bone graft was implanted under direct visualization,followed by fixation of the posterolateral bone mass with a lateral locking plate which was placed as far as possible above the fibular head.The patients were encouraged 6 weeks after surgery to do knee functional exercise within 90°.The therapeutic efficacy was evaluated at the final follow-up according to the Rasmussen's criteria for knee functions.Results The average operative time was 74 minutes (from 55 to 90 minutes);the average intraoperative blood loss was 70 mL (from 40 to 120 mL).All the patients were followed up for 12 to 35 months (average,17.5 months).No neurovascular injury or incision infection was observed.Bony union was achieved in all patients after 10 to 15 weeks (average,12.5 weeks).Follow-ups found no implant loosening/breakage,genu valgum,genu varum,fracture redisplacement,or knee instability.According to the Rasmussen's function evaluation of the knee joint,10 cases were rated as excellent and one as good.Conclusion Lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating is a preferred treatment for simple posterolateral tibial plateau fractures.

Objective:To investigate the effect of different screw and screw hole combination of locking compression plates (LCP) on axial micromotion of fracture ends.Methods:Eighteen mature male New Zealand white rabbits were enrollled and divided into Groups A, B and C according to the random number table method, with six rabbits in each group. After obtaining the whole fresh right tibial specimens, the tibia was cut off transversely at the middle part and fixed with LCP. All specimens were fixed with locking screws in locking holes at the distal side of the fracture end. In Group A, locking screws were fixed in locking holes at proximal end. In Group B, common screws were fixed in locking holes at proximal end. While in Group C, common screws were fixed in compression holes at proximal end. All specimens were subjected to a dynamic axial load of 0-50 N on a universal test machine. The distance of the micromotion of the fracture site was measured and axial compression stiffness corresponding to each fixing method was calculated through the instrument's own system.Results:All specimens generated corresponding axial displacement under the axial load. Under an axial load that approximated a body weight (25 N), the axial displacement value of the fracture end was (0.101±0.017)mm in Group A, (0.164±0.007)mm in Group B, and (0.305±0.041)mm in Group C. Under the axial load of approximately two body weights (50 N), the axial displacement value of the fracture end was (0.218±0.012)mm in Group A, (0.285±0.013)mm in Group B, and (0.513±0.051)mm in Group C. Under the same load, the average axial displacement value of fracture site was Group C>Group B>Group A ( P<0.01). The axial stiffness of LCP device was (234.36±13.28)N/mm in Group A, (203.78±16.46)N/mm in Group B, and (112.62±16.23)N/mm in Group C, namely Group A>Group B>Group C ( P<0.01). Conclusion:LCP fixed with common screws or via compression holes can significantly increase axial micromotion of the fracture end. While the combined application of the two methods has better effect and can reduce the stiffness of LCP device.

Objective: To investigate the clinical efficacy of dynamic anterior plate-screw system (DAPSQ) assisted by preoperative digital design in the treatment of acetabular bi-column fractures. Methods: A retrospective case-control study was conducted to analyze the clinical data of 34 patients with acetabular bi-column fractures admitted to the General Hospital of Central Theater Command from January 2012 to January 2018. There were 24 males and 10 females, aged 21-65 years[(43.0±14.2)years]. According to the treatment method, the patients were divided into Group A treated with DAPSQ assisted by preoperative digital design and Group B treated with conventional DAPSQ.Group A was consisted of 17 patients, including 11 males and six females aged 22-64 years [(42.7±12.4)years]. Group B consisted of 17 patients, including 13 males and four females aged 21-65 years[(43.2±14.6)years]. The operation time, intraoperative blood loss, hospitalization time, fracture healing time, Matta radiological standard score of fracture reduction, Merle d'Aubignre-Postel score and complications were recorded and compared between the two groups. Results: All patients were followed up for 12-62 months [(32.8±9.1)months]. The operation time [(160.8±38.5)minutes] and intraoperative bleeding [(455.6±190.4)ml] in Group A were significantly less than those in Group B [(216.9±59.5)minutes] and [(780.2±211.6)ml] (P<0.05). There were no significant differences in hospitalization time, fracture healing time, Matta radiological standard score, modified Merle d'Aubignre-Postel score at the last follow-up between the two groups (P>0.05). In Group A, four patients had traumatic arthritis, with one patient receiving total hip replacement. In Group B, three patients were found with traumatic arthritis, and one with avascular necrosis of femoral head who underwent total hip replacement. None of the two groups had complications such as screws' entry into articular cavity, failure of internal fixation, and incision infection. Conclusions For acetabular bi-column fractures, DAPSQ can effectively maintain the stability of the fracture, without the risk of screws entering the joint cavity, and obtain satisfactory clinical effect. Compared with conventional DAPSQ, preoperative digital design can significantly shorten the operation time and reduce intraoperative bleeding.