Clinical Research On Treatment Of Comminuted Fracture Of Tibial Plateau By Double Plate

Objective:To summarize the classification and treatment methods of comminuted fractureof tibial plateau and to explore the double steel plate in the treatment of comminutedfracture of tibial plateau.Methods:The19comminuted fracture cases of tibial plateau which have been treated inWujin Hospital of Jiangsu University from June2008to June2011by double steelplate fixation and surgery as supplement have been collected and analyzed. Amongthem,5cases are of Schatzker Ⅳ,13cases of Schatzker Ⅴ and one case of SchatzkerⅥ. In this study, open reduction and internal fixation by supporting plate have beenmade to treat all the cases above. For Schatzker Ⅳ fracture, the steel plate curvedincisions have been made and the below part of meniscus has been cut to expose thearticular cavity and to observe how about the fracture and ligament injury. Besides, aT-shaped supporting plate is placed in the medial tibial and lateral supporting plate(“golf” plate) is used in the lateral tibial for fixation. For Schatzker Ⅴ and Ⅵ,S-shaped anterior median incision has been made. And then reduce the comminutedfracture blocks, pry the collapsed articular surface, support and pry cartilage articularsurface, dissect and reduce the fracture blocks, so as to restore the tibia articularsurface to flat. In the following, bone graft is made to the defect of cancellous boneunder the cartilage surface. After the bone grafting, the L-shaped or T-shapedsupporting plate is pre-bent and shaped and then it’s been placed in the condyle ofmedial tibial and lateral supporting plate (“golf” plate) is used in the lateral tibial forfixation. The supporting L-shaped and T-shaped plates in this study are provided byTrauson Medical Instrument Co. Ltd or Synthes Medicine Instrument Co. Ltd. The functional exercise has been taken in the initial stage after operation.Results:Follow-up visits have been made for these19cases in the36months from theoperation by outpatient service and telephone interview. It is found that all the caseshave healed and the average healing period is two months and a half, without anyfailure like varus and valgus deformity, plate and screw breakage, deep infection ormedial-lateral fixation failure. According to the Rasmussen Grading Standard whichassesses the comprehensive recovery of the knee function, the rating scale can bedivided into excellence, good, fair and poor. The rate of excellence and good recoveryof Ⅳ, Ⅴ and Ⅵ reached80%,84.6%and100%respectively.Conclusion:From the perspective of clinical treatment, the proper surgical approach, theprotection of soft tissue surrounding the knee joint to avoid excess flaking of thesurrounding tissue and the destroy of blood supply, anatomical reduction of articularsurface, the stabilized internal fixation, the good bone grafting, and the properfunctional training in the early stage after the operation are all key to achieving a goodresult in the treatment of comminuted fracture of tibial plateau by double steel plates.