Efficacy of dual-approach bicondylar fixation under adjustable positioning for Schatzker type IV trans-midline tibial plateau fractures
10.3760/cma.j.cn501098-20250220-00094
- VernacularTitle:可变体位下双入路、双平台内固定治疗“Schatzker Ⅳ型过中线”胫骨平台骨折的疗效
- Author:
Guqi HONG
1
;
Tianrun LYU
1
;
Yu ZHANG
1
;
Jiahu FANG
1
;
Lijun SONG
1
;
Xiang LI
1
Author Information
1. 南京医科大学第一附属医院骨科，南京 210029
- Publication Type:Journal Article
- Keywords:
Tibial fractures;
Fracture fixation, internal;
Surgical approach
- From:
Chinese Journal of Trauma
2025;41(6):580-586
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the clinical outcomes of dual-approach bicondylar fixation under adjustable positioning for Schatzker type IV trans-midline tibial plateau fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 52 patients with Schatzker type IV trans-midline tibial plateau fractures admitted to First Affiliated Hospital to Nanjing Medical University from January 2014 to August 2023, including 37 males and 15 females, aged 19-68 years [(42.3±14.0)years]. All the patients were treated with the surgical scheme of anterior and medial dual-approach bicondylar internal fixation under adjustable positioning. The operation duration, intraoperative blood loss, and fracture healing time were counted. X-ray films were reviewed at 2 days after surgery for residual knee subluxation. At 2 days, 3 and 6 months after surgery, and at the last follow-up, the tibial plateau angle (TPA) and posterior slope angle (PA) were measured with follow-up X-ray films to evaluate whether there was loss of reduction. The knee function was evaluated with the American Hospital for Special Surgery (HSS) knee function score at 3 and 6 months after surgery and at the last follow-up. The anterior posterior displacement and rotation stability of the knee were evaluated with Lachman test and pivot-shift test at the last follow-up. The postoperative complications were recorded.Results:All the patients were followed up for 12-118 months [70(46, 85)months]. The operation duration was 100-180 minutes [145(120, 160)minutes], with intraoperative blood loss of 100-550 ml [(323.8±135.1)ml]. Fractures were healed well in all the patients, with the healing time of 2-4 months [3.0(2.4, 3.5)months]. None of the patients had residual subluxation by X-ray films at 2 days after surgery. There were no significant differences in TPA or PA at each time point after surgery ( P>0.05). The HSS knee function score was (69.4±4.9)points, (80.9±7.0)points, and (90.1±7.9)points at 3 and 6 months after surgery and at the last follow-up, respectively and the score gradually increased with the passage of time ( P<0.05). At the last follow-up, all the patients were negative in Lachman test and pivot-shift test. Three patients developed fat liquefaction around medial wounds after surgery, which were healed after dressing change. While the wounds were healed by first intention in the other patients. Postoperative complications such as knee instability, implant loosening, fracture or refracture not occurred. Conclusion:Dual-approach bicondylar fixation under adjustable positioning for Schatzker type IV trans-midline tibial plateau fractures has the advantages including high fracture healing rate, precise fracture reduction and fixation, satisfactory postoperative functional recovery and fewer complications, without increasing operation duration or intraoperative blood loss.
