Mankar Sushil H, Golhar Anil V, Shukla Mayank, Badwaik Prashant S, Faizan Mohammad, Kalkotwar Sameer
Department of Orthopaedics, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, India.
Indian J Orthop. 2012 Sep;46(5):570-4. doi: 10.4103/0019-5413.101041.
Tibial plateau fractures are usually associated with communition and soft tissue injury. Percutaneous treatment of these complex fractures is intended to reduce soft issue complications and postoperative stiffness of the knee joint. We assessed the complications, clinical outcome scores, and postoperative knee range of movements, after fluoroscopic assisted closed reduction and external fixator application.
Seventy eight complex tibial plateau fractures in 78 patients were included in the study. All fractures were managed with closed reduction and external fixator application. In 28 cases with intraarticular split, we used percutaneous cancellous screw fixation for reduction and fixation of condylar parts. In nine open fractures, immediate debridement was done. In 16 cases, elevation of depressed segment and bone grafting was required, which was done from a very small incision. All patients were clinically and radiographically evaluated at a mean followup of 26.16 months (range 6-60 months).
Clinical results were evaluated according to the Rasmussen's criteria. Average healing time was 13.69 weeks (range 12- 28 weeks). Mean knee range of motion was 122.60° (range 110°-130°). Forty seven results were scored as excellent, 25 good, 2 fair, and 1 as poor.
We believe that minimally invasive treatment by percutaneous techniques and external fixation is a fairly reasonable treatment alternative, if near anatomical reduction of joint surface can be confirmed on fluoroscopy.
胫骨平台骨折通常伴有粉碎性骨折和软组织损伤。这些复杂骨折的经皮治疗旨在减少软组织并发症和膝关节术后僵硬。我们评估了在透视辅助下闭合复位并应用外固定器后的并发症、临床结果评分以及术后膝关节活动范围。
本研究纳入了78例患者的78例复杂胫骨平台骨折。所有骨折均采用闭合复位及外固定器固定。对于28例关节内劈裂骨折，我们采用经皮松质骨螺钉固定来复位和固定髁部。对于9例开放性骨折，立即进行了清创。在16例病例中，需要抬高塌陷骨块并植骨，通过一个非常小的切口完成。所有患者在平均随访26.16个月（范围6 - 60个月）时进行了临床和影像学评估。
根据拉斯穆森标准评估临床结果。平均愈合时间为13.69周（范围12 - 28周）。膝关节平均活动范围为122.60°（范围110° - 130°）。47例结果评为优秀，25例良好，2例一般，1例差。
我们认为，如果在透视下能确认关节面接近解剖复位，经皮技术和外固定的微创治疗是一种相当合理的治疗选择。
