Comparison Of The Short-term Clinical Efficacy Of The Treatment Of Complex Tibial Plateau Fractures With Internal And External Double Plate And Lateral Single Plate Fixation

Objective:To compare the recent clinical effects of the treatment of complex tibial plateau fractures with internal and external double plates and lateral single plate.Methods:From September 2013 to November 2017,the clinical effects of 38 patients with complex tibial plateau fractures treated with internal and external double plates and lateral single plate respectively were retrospectively analyzed in Orthopaedics Dept.,Zhangjiagang No.2 People's Hospital.Among them,18 patients with complex tibial plateau fractures were treated with internal and external double plates(internal and external group),and 20 patients were treated with external single plate(external group).General data,operation time,intraoperative blood loss,related complications,quality of reduction,weight-bearing walking time and knee joint function were compared between the two groups.Fractures were classified according to Schazker and three-column classification criteria.Patients in both groups were followed up from 9 to 56 months.Postoperative complication data included incision infection,skin necrosis,internal fixation loosening or breakage,and collapse of articular surface.Positive and lateral radiographs of the knee joint were taken preoperatively,1 to 3 days postoperatively and during regular postoperative review.All radiographs were reviewed by the surgeon and senior orthopedic doctors.The quality of reduction was evaluated according to Rasmussen's anatomical scoring criteria for tibial plateau fractures,and the time of weight-bearing walking after surgery was calculated.Rasmussen's scoring system and HSS knee joint scoring system were used for evaluation of knee joint function,respectively.Results:According to data analysis,there was no statistically significant difference in general data between the two groups(P>0.05).The average operating time was(102.2�11.8)min(85 to 125 min)in the internal and external group,the average blood loss was(255.6�95.3)ml(150 to 450 ml),and the average hospitalization time was(14.8�3.5)days(8 to 22 days)in the internal and external group.Postoperative complications occurred in 4 cases(22.2%)in internal and external group,including 2 cases of incision infection,which were healed after debridement and dressing change.Skin necrosis was observed in 2 cases,which were local skin necrosis between internal and external incisions after surgery,without bone exposure,and healed after debridement+VSD attraction and other treatments.No internal fixation loosening or breakage,collapse of articular surface,nerve injury.According to Rasmussen's anatomical scoring criteria for tibial plateau fractures,there were 12 excellent cases,5 good cases,1 fair case and 0 poor cases in the internal and external group,achieved in 94.5%satisfactory clinical results.The average weight-bearing walking time of the internal and external group to the crutch was(10.5�1.4)weeks(9 to 13 weeks).According to Rasmussen knee joint function scoring system:in the internal and external group,there were 10 excellent cases,6 good cases,1 fair case and 1 poor case,with an average score of(24.9 � 5.6)points and achieved in 88.9%satisfactory clinical results.According to the HSS knee joint function scoring system:in the internal and external group,there were 10 excellent cases,6 good cases,1 fair case and 1 poor case,with an average score of(87.1 � 10.2)points and achieved in 88.9%satisfactory clinical results.The average operating time in the external group was(86.5�26.7)min(55 to 150 min),and the average blood loss was(147.5�99.3)ml(50 to 400 ml).The average hospitalization time of the external group was(13.9 � 4.4)days(5 to 20 days).Postoperative complications occurred in 3 cases(15.0%)in the external group,including 1 case of incision infection,which was healed after debridement and dressing change.1 case had skin necrosis,which was preoperative upper tibia combined with skin contusion,and postoperative local skin necrosis at the incision without internal fixation or bone exposure.It was healed after debridement and dressing change.1 case was collapse of articular surface.The patient walked with heavy load in the early stage,and the collapse of the internal platform and internal column was about 5mm after surgery.The patient's function was not significantly affected.No internal fixation loosening or breakage,nerve injury.According to Rasmussen's anatomical scoring criteria for tibial plateau fractures,12 cases in the the external group were excellent,5 cases good,3 cases fair,and 0 case poor,achieved in 85.0%satisfactory clinical results.The average weight-bearing walking time of the external group was(11.9�1.7)weeks(10 to 15 weeks).According to Rasmussen knee joint function scoring system,in the external group,there were 12 excellent cases,5 good cases,2 fair cases and 1 poor case,with an average score of(24.7 � 6.1)points and achieved in 85.0%satisfactory clinical results.According to the HSS knee joint function scoring system:in the external group,there were 11 excellent cases,5 good cases,3 fair cases and 1 poor case,with an average score of(87.4�10.9)points and achieved in 80%satisfactory clinical results.Conclusion:In the treatment of complex tibial plateau fractures,the treatment with internal and external double plates has advantages in fracture reduction,early weight-bearing time and prevention of recollapse of articular surface,but the surgical trauma is large and the incidence of complications such as infection and skin necrosis is increased.The procedure is relatively simple when the lateral plate is used,but the situation of fracture of the internal platform should be considered comprehensively.