Effects of reduction sequences on the surgical treatment of Schatzker type Ⅳ tibial plateau fractures with coronal plane subluxation
10.3760/cma.j.cn115530-20240818-00343
- VernacularTitle:复位顺序对手术治疗伴冠状面半脱位Schatzker Ⅳ型胫骨平台骨折的效果影响研究
- Author:
Chuanyuan CHEN
1
;
Yangkai XU
1
;
Biao WANG
1
;
Fengfei LIN
1
Author Information
1. 福州市第二总医院骨科，福建省创伤骨科急救与康复临床医学研究中心，福州 350007
- Publication Type:Journal Article
- Keywords:
Tibial fractures;
Fracture fixation, internal;
Subluxation;
Reduction sequence;
Tibial plateau
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(3):234-241
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the impacts of 2 reduction sequences on the surgical treatment of Schatzker type Ⅳ tibial plateau fractures with coronal plane subluxation.Methods:A retrospective analysis was conducted of the 53 patients who had been treated for Schatzker type Ⅳ tibial plateau fractures with coronal plane subluxation at Department of Orthopaedics, Fuzhou Second General Hospital from June 2020 to October 2023. The patients were divided into 2 groups according to the 2 reduction sequences employed during surgery. In the observation group of 25 patients [16 males and 9 females with an age of (47.2±10.2) years], the coronal plane subluxation was first reduced and temporarily fixed, followed by reduction of the medial plateau, and fixation of both the medial and lateral plateaus. In the control group of 28 patients [13 males and 15 females with an age of (50.6±15.4) years], in the traditional manner, the medial plateau was first reduced and temporarily fixed, followed by reduction of the coronal plane subluxation and finally by fixation of both plateaus. Outcomes compared between the 2 groups included surgical duration, intraoperative blood loss, and fracture healing time. Additionally, postoperative outcomes were assessed on the second day after surgery using such parameters as medial proximal tibial angle, lateral plateau widening, rate of coronal plane subluxation, and Rasmussen score. Knee joint function was evaluated at the final follow-up.Results:No significant differences were found between the 2 groups in baseline characteristics, ensuring comparability ( P>0.05). The mean follow-up duration for all patients was (12.6±4.2) months. There were no significant differences in surgical duration, intraoperative blood loss, fracture healing time or medial proximal tibial angle between the 2 groups ( P>0.05). The observation group demonstrated a significantly higher success rate by Rasmussen score (100.0% [25/25]) than the control group (78.6% [22/28]), significantly smaller postoperative lateral plateau widening [(3.70±2.42) mm] than the control group [(5.79±3.38) mm], a significant lower rate of coronal plane subluxation [16.0% (4/25)] than the control group [42.9% (12/28)], a significantly higher Hospital for Special Surgery (HSS) knee score [(83.8±5.4) points] than the control group [(80.0±6.5) points] (all P<0.05). Conclusion:Compared to the traditional reduction sequence, the modified reduction sequence prioritizing the reduction of coronal plane subluxation during surgery for Schatzker type Ⅳ tibial plateau fractures with coronal plane subluxation leads to superior short-term outcomes, effectively reduced widening of postoperative lateral tibial plateau and a decreased rate of coronal plane subluxation.
