R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Injury. 2020 Jul;51(7):1662-1668. doi: 10.1016/j.injury.2020.03.037. Epub 2020 Apr 19.
We assessed the outcome and safety of posterior plating of distal tibial fractures.
We conducted a retrospective case series at a Level I trauma center. Seventy-four consecutive patients with distal tibial fractures treated with anatomically contoured 3.5-mm T-shaped locking compression plate using a posterolateral approach from January 2008 through April 2018 were included in the study. The mean patient age was 48 years (range, 18-87 years). Fifty-nine percent of the patients were male patients, 47% of the fractures were open fractures; and 27% of the patients had multiple traumatic injuries. Eleven fractures were AO/OTA type 42, 22 were type 43A, and 41 were type 43C. Sixty-two (84%) patients were treated with initial spanning external fixation (median time, 23 days) and staged open reduction and internal fixation. The main outcome measure was unplanned reoperation to address implant failure, nonunion, deep surgical site infection, or symptomatic implant.
Overall risk of unplanned reoperation was 15% (11 of 74 patients, 95% confidence interval, 9%-25%). Four (5%) reoperations were for nonunion, three (4%) were for surgical site infection, two (3%) were for infected nonunion, and two (3%) were for implant prominence. Loss of alignment >10 degrees occurred in one patient who underwent unplanned reoperation for nonunion. No plate breakage occurred. Median time to reoperation was 221 days (range, 22-436 days). Only one other complication was noted: wound dehiscence associated with the posterolateral approach, which was treated with irrigation and débridement and a 6-week regimen of oral antibiotics.
Use of a posterolateral approach with a pre-contoured locking compression T-plate for the treatment of distal tibial fractures led to reasonable outcomes with an acceptable risk of unplanned reoperation, even with a high proportion of open fractures commonly staged with external fixation.
我们评估了后外侧入路 T 型锁定加压接骨板治疗胫骨远端骨折的疗效和安全性。
我们在一家 1 级创伤中心进行了回顾性病例系列研究。纳入 2008 年 1 月至 2018 年 4 月间采用后外侧入路 T 型解剖锁定加压接骨板治疗的 74 例胫骨远端骨折患者。患者平均年龄 48 岁（18-87 岁）。59%为男性，47%为开放性骨折，27%合并多发创伤。骨折按 AO/OTA 分型：42 型 11 例，43A 型 22 例，43C 型 41 例。62 例（84%）患者行初始跨关节外固定架固定（中位时间 23 天），二期行切开复位内固定。主要观察指标为内固定失败、骨不连、深部手术部位感染或有症状的内固定相关再手术。
总的再手术率为 15%（11/74 例，95%置信区间 9%-25%）。4 例（5%）因骨不连再次手术，3 例（4%）因手术部位感染，2 例（3%）为感染性骨不连，2 例（3%）为内固定物突出。1 例因骨不连再次手术患者发生 10°以上的对线不良。无钢板断裂发生。再手术中位时间 221 天（22-436 天）。另 1 例发生切口并发症：后外侧入路相关的切口裂开，予清创冲洗及 6 周的口服抗生素治疗。
胫骨远端骨折采用后外侧入路 T 型锁定加压接骨板治疗可获得较好的疗效，再手术率可接受，即使开放性骨折比例较高且多采用外固定分期治疗，也不增加再手术风险。
