Treatment of complex tibial plateau fractures with multiplates through two combined approaches

Objective To evaluate the outcomes after open reduction and internal fixation of com-plex tibial plateau fractures with multiplates through the posterior reversed L-shaped approach combined with the traditional anterolateral approach. Methods From July 2007 to July 2013, 75 comminuted fractures of tibial plateau were treated with multiplates through the above two incisions and available for complete fol-low-up. They were 53 males and 22 females, with a mean age of 46.5 years. By Schazker classification, 10 cases were type Ⅲ, 14 type Ⅳ, 15 type Ⅴ, and 36 type Ⅵ; by "three-column" concept, 5 cases were fractures of medial column plus posterior column, 9 fractures of lateral column plus posterior column, and 61 fractures of three columns. The internal fixation was assessed by measuring the tibial plateau angle (TPA) and posterior slope angle (PA) on the X-ray films at immediate postoperation, 3 months and one year after oper-ation. At the final follow-ups, the knee flexion and extension were measured and the health status and functional recovery of the knee assessed using the Hospital for Special Surgery (HSS) score and the Short Form-36 (SF-36) in all the patients. Results The 75 patients were followed up for an average duration of 48.4 months (range, from 12.4 to 83.8 months). On average, the fractures healed after 15.4 weeks, and full weight-bearing was achieved after 13.5 weeks. At the last follow-ups, the knee flexion achieved 125.0° and the extension 2.8°; the HSS scores averaged 95.8 points and SF-36 93.9 points at one year follow-ups. Comparisons concerning TPA and PA between immediate postoperation, 3 weeks and one year after operation showed no significant differences (P >0.05). Rupture of the popliteal artery occurred in one, the nutrient vessel of the gastrocnemius muscle was cut in one during the operation, skin anaesthesia appeared at the distal posterior reversed L-shaped incision postoperatively, and deep infection was observed at the site of anterolateral incision in one. The total rate of complications was 5.3% (4/75). Conclusion The treatment of complex tibial plateau fractures with mutliplates through the posterior reversed L-shaped approach combined with the traditional anterolateral approach can result in good exposure, stable fixation, a low complication rate and satisfying knee function. Key words: Tibial fractures; Knee joint; Fracture fixation, internal; Bone plates