[Treatment of Schatzker V/VI tibial plateau fracture involved posteromedial condyle through combined approach].

OBJECTIVE

To observe the clinical results of treatment of Schatzker V/VI tibial plateau fracture involved posteromedial condyle through combined posteromedial and anterolateral approach and fixed with two or three plates.

METHODS

From April 2005 to April 2008, 18 cases of tibial plateau fracture involved posteromedial condyle were treated, including 14 males and 4 females with an average age of 38.5 years old (range, 18-62 years old). According to Schatzker classification, there were 12 cases of type V and 6 cases of type VI. The posteromedial condyle were involved in 13 cases and bilateral posterior condyle in 5 cases. All patients were given posteromedial fragment and medial condyle fracture reduction through posteromedial approach firstly, and then lateral condyle fracture reduction through anterolateral approach, and injury of meniscus and cruciate ligaments were treated at the same time. Three plates (lateral, medial, posterior) were used in 10 cases and two plates (lateral, posteromedial) in 8 cases.

RESULTS

All wounds achieved healing by first intention without complications such as infection, flap necrosis, osteofascial compartment syndrome, chronic osteomyelitis, nonunion. All patients were followed up for 12 to 48 months with an average of 24.4 months. The mean flexion of the knee was 118.4 degrees (range, 100-130 degrees) 1 year after operation. According to Iowa evaluation system, 12 patients got excellent results, 4 good, and 2 fair; the excellent and good rate was 88.9%.

CONCLUSION

Combined posteromedial and anterolateral approach and fixed with two or three plates is effective in treatment of the Schatzker V/VI tibial plateau fracture involved posteromedial condyle. Anatomical reduction and rigid internal fixation of the posteromedial fragment are critical to successful operation.