Universität zu Köln

Chang, Shi-Min, Hu, Sun-Jun, Zhang, Ying-Qi, Yao, Meng-Wei, Ma, Zuo, Wang, Xin, Dargel, Jens and Eysel, Peer (2014). A surgical protocol for bicondylar four-quadrant tibial plateau fractures. Int. Orthop., 38 (12). S. 2559 - 2565. NEW YORK: SPRINGER. ISSN 1432-5195

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Abstract

Purpose Bicondylar tibial plateau fractures involving four articular quadrants are severe and complex injuries, and they remain a challenging problem in orthopaedic trauma. The aim of this study was to introduce a new treatment protocol with dual-incision and multi-plate fixation in the floating supine patient position as well as to report the preliminary clinical results. Methods From January 2006 to December 2011, 16 consecutive patients with closed bicondylar four-quadrant tibial plateau fractures (Schatzker type VI, OTA/AO 41C2/3) were treated with posteromedial inverted L-shaped and anterolateral incisions. With the posteromedial approach, three quadrants (posteromedial, anteromedial and posterolateral) can be exposed, reduced and fixed with multiple small antiglide plates and short screws in an enclosure pattern. With the anterolateral approach, after articular elevation and bone substitute grafting, a strong locking plate with long screws to the medial cortex is used to raft-buttress the reduced lateral plateau fracture, hold the entire reconstructed tibial condyles together, and contact the condyles with the tibial shaft. All patients were encouraged to exercise knee motion at an early stage. The outcome was evaluated clinically and radiologically after a minimum two-year follow-up. Results The average operation time was 98 +/- 26 minutes (range 70-128) and the average duration of hospitalization was 29 +/- 8.6 days (range 20-41). Three cases used five plates, nine cases used four plates, and four cases used three plates. All patients were followed for a mean of 28.7 +/- 6.1 months (range 26-38). Fifteen incisions healed initially, while one patient developed a medial wound dehiscence and was successfully managed by debridement. All patients achieved radiological fracture union after an average of 20.2 weeks. At the two-year follow up, the average knee range of motion (ROM) was 98A degrees aEuro parts per thousand A +/- aEuro parts per thousand 13.7 (range 88-125A degrees), with a Hospital for Special Surgery (HSS) knee score of 87.7 A +/- 10.3 (range 75-95), and SMFA score of 21.3 A +/- 8.6 (range 12-33). Conclusion For bicondylar four-quadrant tibial plateau fractures, the treatment protocol of multiple medial-posterior small plates combined with a lateral strong locking plate through dual incisions can provide stable fracture fixation to allow for early stage rehabilitation. Good clinical outcomes can be anticipated.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Chang, Shi-Min UNSPECIFIED UNSPECIFIED UNSPECIFIED Hu, Sun-Jun UNSPECIFIED UNSPECIFIED UNSPECIFIED Zhang, Ying-Qi UNSPECIFIED UNSPECIFIED UNSPECIFIED Yao, Meng-Wei UNSPECIFIED UNSPECIFIED UNSPECIFIED Ma, Zuo UNSPECIFIED UNSPECIFIED UNSPECIFIED Wang, Xin UNSPECIFIED UNSPECIFIED UNSPECIFIED Dargel, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Eysel, Peer UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-422144
DOI:	10.1007/s00264-014-2487-7
Journal or Publication Title:	Int. Orthop.
Volume:	38
Number:	12
Page Range:	S. 2559 - 2565
Date:	2014
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-5195
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language POSTEROMEDIAL FRAGMENT; CLASSIFICATION; FIXATION; MORPHOLOGY; PATTERNS; OUTCOMES; SYSTEM Multiple languages Orthopedics Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/42214