"T" Shaped Locking Plate Through Carlson Posterior-lateral Approach For Posterolateral Tibial Plateau Fractures: 12 Months Follow-up Evaluation

Objective : To explore the clinical effect of two kinds of surgical approaches for the treatment of posterolateral tibial plateau fractures with "T" shaped locking plate.Methods:Retrospective analysis of July 2011 to 2014 July admitted to our department of tibial plateau fracture 43 patients, which 25 cases of male, 18 female patients, ranging in age from 17 to 54 years average 34.1 years. 7 cases for simple lateral compression fractures, 15 cases for lateral split crack compression fractures, 21 cases for posterolateral splitting fractures caused by posterior shift; 17 cases motorcycle traffic accident injury and other reasons(such as a fall from a height, sprain, etc) damage in 26 cases. Patients admitted to the hospital after the inquiry medical history and careful physical examination, prior to the determination of injury were no knee dysfunction,after injury complicated with vascular, nerve injury and osteofascial compartment syndrome. Routine line MRI, CT+3D to check the situation of fracture, selected pure tibial plateau fracture of lateral, lateral tibia articular surface collapse >2mm, fractures of the lateral or lateral platform sagittal broadening >5mm tibial platform; routine of the calcaneus or skin traction before operation, given anticoagulant swelling treatment, given operative treatment in 5 to 8 days after trauma. Carlson posterolateral approach in 22 cases, posterior midline approach in 21 cases. The above two kind of surgery in the age and sex of the road structure, operation such as fracture exposure time,operation time, amount of bleeding, fracture healing, such as fracture healing time completely load time, postoperative immediate and postoperative 12 months TPA and PA and postoperative review knee joint function recovery such as 12 months HSS score, Rasmussen score to make a comparison and statistical analysis.Results : 43 cases(knees) were obtained from the patients with posterolateral tibial plateau fractures(43 knees) were followed strictly. The average operation time of two surgical approaches were 94 min and 95 min respectively, the average fracture healing time was 17.05 weeks and 16.90 weeks respectively. The average total load time was 17.50 weeks and 17.76 weeks respectively. 12 months post-operation the average score of Hospital for Special Surgery(HSS) was 85.41 points and 88.43 points respectively. All above were no statistically significant differences. Both TPA(tibial plateau angle) and PA(posterior slope angle) on the radiographies between immsdiate post-operation and 12 months post-operation were no significant differences.The average time of fracture exposure was 25 min and 35 min respectively, and the average bleeding volume was 229.52 ml and 270.45 ml respectively. 12 months post-operation the total excellent and good rate Rasmussen was 90.91%and 61.90% respectively. All above were statistically significant differences.Conclusion:For a single fracture or collapse of the posterolateral tibial plateau fractures, Carlson posteriorlateral approach and posterior midline approach can achieve full and direct exposure. But Carlson posterior-lateral approach has shown it’s advantages including short fracture exposure time, less bleeding,good recovery of joint function.