Reul M, Johnscher F, Nijs S, Hoekstra H
Unfallchirurgie, Universitätsklinikum Leuven, Herestraat 49, 3000, Leuven, Belgien.
Medizinische Fakultät, Technische Universität Dresden, 01307, Dresden, Deutschland.
Oper Orthop Traumatol. 2017 Oct;29(5):431-451. doi: 10.1007/s00064-017-0502-z. Epub 2017 Jun 9.
Exact reconstruction of the depressed articular surface and stable subchondral fixation of the lateral tibial plateau (ORIF, "open reduction and internal fixation").
Tibial plateau fractures with involvement of the lateral column and depression of the articular surface.
Critical soft tissue. Severe osteoporosis.
Supine position, classical anterolateral approach, lateral submeniscal arthrotomy, visualisation of the fracture, osteotomy of the lateral tibial condyle. Reconstruction of the articular surface under visual control and temporary fixation with Kirschner wires. One or more 2.7 mm locking screws are placed subchondral for permanent stable fixation of the articular surface. If needed, the metaphyseal bone defect is filled with autologous or allogenic bone graft. The lateral tibial condyle is reduced and a 3.5 mm (variable angle) locking compression plate applied. Closure of fascia and skin in layers.
FOLLOW-UP MANAGEMENT: Free range of motion, in case of residual instability of the collateral ligaments varus-valgus stabilizing brace, partial weight-bearing of 10-15 kg for 8 weeks, control computed tomography (CT) scan after 3 months.
Since February 2014, a total of 23 lateral tibial plateau fractures were treated using the described technique; 4 patients were lost to follow-up and the 3‑month follow-up of 2 patients is not completed yet. After an average of 167 days, 11 patients had no complaints. At approximately 3 months postoperatively, 10 patients had full range of motion, 3 had a flexion deficit of at least 30°, and 2 patients had residual instability of the medial collateral ligament. One postoperative superficial infection was noted. At the 3 month CT, 10 of 17 patients showed successful reduction without significant articular steps or anatomical malalignment.
精确重建胫骨外侧平台凹陷的关节面并实现稳定的软骨下固定（切开复位内固定术，“ORIF”）。
累及外侧柱且关节面凹陷的胫骨平台骨折。
严重软组织损伤。严重骨质疏松。
仰卧位，经典前外侧入路，半月板下外侧关节切开术，骨折可视化，胫骨外侧髁截骨术。在直视下重建关节面并用克氏针临时固定。在软骨下放置一根或多根2.7毫米锁定螺钉以实现关节面的永久稳定固定。如有需要，用自体或异体骨移植填充干骺端骨缺损。复位胫骨外侧髁并应用一块3.5毫米（可变角度）锁定加压钢板。分层缝合筋膜和皮肤。
活动范围不受限，若侧副韧带残留不稳定则使用内翻-外翻稳定支具，8周内部分负重10-15千克，3个月后行计算机断层扫描（CT）检查。
自2014年2月以来，共有23例胫骨外侧平台骨折采用上述技术治疗；4例患者失访，2例患者的3个月随访尚未完成。平均167天后，11例患者无不适主诉。术后约3个月时，10例患者活动范围正常，3例患者屈曲受限至少30°，2例患者内侧副韧带残留不稳定。记录到1例术后浅表感染。在3个月的CT检查中，17例患者中有10例显示复位成功，无明显关节台阶或解剖学错位。
