Dual anteromedial and anterolateral approaches versus anterior midline approach for Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse
10.3760/cma.j.cn115530-20241204-00466
- VernacularTitle:膝内外双入路与膝前正中入路治疗伴后柱塌陷的Wahlquist C型胫骨内侧平台骨折的疗效比较
- Author:
Yunqin XU
1
;
Qiangqiang WEI
1
;
Yong TANG
1
;
Pan DENG
1
;
Yourong YAO
1
;
Zhengli LUO
1
;
Wei CHEN
1
;
Chengbin QIU
1
;
Haiqiang SHEN
1
;
Haitang LI
1
;
Mengyun ZHOU
1
Author Information
1. 解放军陆军第七十二集团军医院骨科四病区，湖州 313000
- Publication Type:Journal Article
- Keywords:
Tibial fractures;
Fracture fixation, internal;
Osteotomy;
Approach
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(8):721-725
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the therapeutic efficacy of the dual anteromedial and anterolateral approaches versus that of the anterior midline approach in the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse.Methods:A retrospective study was conducted to analyze the 21 patients who had been treated for Wahlquist type C medial tibial plateau fractures plus posterior column collapse at The Fourth Orthopedic Ward, The 72nd Group Army Hospital of PLA between January 2019 and August 2023. The cohort included 13 males and 8 females, with an age of (43.3±6.7) years. The left side was involved in 14 fractures and the right side in 7 ones. The patients were divided into 2 groups based on their surgical approaches: a dual-approach group ( n=13) undergoing fixation via the dual anteromedial and anterolateral approaches, and a single-approach group ( n=8) undergoing fixation via the anterior midline approach. Comparative parameters included operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, medial proximal tibial angle (MPTA), incision complications, postoperative bone mass reduction quality (evaluated according to the Rasmussen anatomical criteria for tibial condyle fracture reduction), lateral tibial plateau instability, incidence of genu varum, and post-traumatic arthritis. Functional recovery of the lower limb joints was assessed at the final follow-up using the Merchant criteria. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups preoperatively, indicating comparability ( P>0.05). All patients were followed up for a mean duration of (38.1±11.3) months. The postoperative MPTA in the dual-approach group (86.8°±0.8°) was significantly larger than that in the single-approach group (85.5°±0.9°) ( P<0.05). Genu varum occurred in 1 patient in the dual-approach group and in 4 patients in the single-approach group, while lateral tibial plateau instability was observed in 1 patient in the dual-approach group and in 4 patients in the single-approach group, showing statistically significant differences between the 2 groups ( P<0.05). No statistically significant differences were found between the 2 groups regarding operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, incidence of incision complications, or incidence of post-traumatic arthritis ( P>0.05). At the final follow-up, no statistically significant difference was observed in the functional recovery of the lower limb joints assessed by the Merchant criteria between the 2 groups ( P>0.05). Conclusion:In the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse, compared with the single anterior midline approach, the dual anteromedial and anterolateral approaches can restore more effectively the MPTA, and reduce the incidences of genu varum and lateral tibial plateau instability.
