FIFA Medical Centre of Excellence, Division of Knee Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Str. 51, 81547 Munich, Germany; Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany.
FIFA Medical Centre of Excellence, Division of Knee Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Str. 51, 81547 Munich, Germany; Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria.
Injury. 2020 Oct;51(10):2295-2301. doi: 10.1016/j.injury.2020.07.012. Epub 2020 Jul 5.
The design of anatomically precontoured locking compression plates (LCP) allows the placement of angular stable screws right underneath the reduced joint surface fragments. To date, there is a lack of evidence supporting the broad utilization of these implants in split depression fractures to the lateral tibial plateau. Thus, aim of the present matched pair retrospective cohort study was to investigate the radiological and clinical outcomes of anatomically precontoured LCP compared to conventional plate and screw osteosynthesis in Schatzker II fractures.
The institutional databank was searched for Schatzker II fractures from 2010 to 2016. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm LCP or conventional 4.5 mm l-shaped plates and screws were included. CT scans and radiographs were analyzed. Details of the operative procedures and secondary events were collected. A matched pair analyses was conducted in a best fit manner. The primary outcome parameter was the Rasmussen Radiological Score approximately one year postoperatively. Secondary outcome parameters were the medial proximal tibial angle (MPTA), the Rasmussen Clinical Score and the WOMAC Score after a follow up of at least three years.
A total of 50 patients was included. Patient age, gender distribution, size and depression depth of the lateral joint surface fragments, frequency of utilizing bone grafts or substitutes and lateral meniscus repair as well as subsequent implant removal were comparable across the groups. Immediately postoperatively, the Rasmussen Radiological Score revealed no differences. After a mean of 64.2 weeks, the radiological outcome was significantly better in the LCP 3.5 group (RRS 8.2 vs. 6.3 points, p<0.001; MPTA 89.5 vs. 92.0°, p = 0.001). After a mean clinical follow-up of 4.5 years, the Rasmussen Clinical Score (22.9 vs. 27.8 points, p<0.001) and the WOMAC score (24.3 vs. 16.0 points, p = 0.04) revealed significantly impaired results in the conventional group.
Anatomically precontoured LCP prevent the subsidence of the reduced joint surface fragments more sufficiently and allow for improved patient outcomes compared to conventional plates and screws. The utilization of anatomically precontoured LCP should therefore closely be considered for internal fixation of any split depression fractures to the lateral tibial plateau.
解剖预成型锁定加压钢板（LCP）的设计允许在关节面下的骨折块下放置角度稳定螺钉。迄今为止，缺乏证据支持这些植入物在外侧胫骨平台劈裂凹陷骨折中的广泛应用。因此，本回顾性配对队列研究的目的是比较解剖预成型 LCP 与传统钢板和螺钉内固定治疗 Schatzker II 型骨折的影像学和临床结果。
从 2010 年至 2016 年，在机构数据库中搜索 Schatzker II 型骨折患者。纳入接受解剖预成型 3.5mm LCP 或传统 4.5mm L 形钢板和螺钉切开复位内固定的患者。分析 CT 扫描和 X 线片。收集手术过程和次要事件的详细信息。采用最佳拟合方法进行配对分析。主要观察指标为术后约 1 年的 Rasmussen 影像学评分。次要观察指标为内侧胫骨近端角（MPTA）、Rasmussen 临床评分和 WOMAC 评分，随访时间至少 3 年。
共纳入 50 例患者。患者年龄、性别分布、关节面下骨折块的大小和深度、植骨或替代物的使用频率以及外侧半月板修复和随后的植入物取出情况在两组间无差异。术后即刻，Rasmussen 影像学评分无差异。平均随访 64.2 周后，LCP 3.5 组的影像学结果明显更好（RRS 8.2 分比 6.3 分，p<0.001；MPTA 89.5 度比 92.0 度，p=0.001）。平均临床随访 4.5 年后，Rasmussen 临床评分（22.9 分比 27.8 分，p<0.001）和 WOMAC 评分（24.3 分比 16.0 分，p=0.04）显示传统组结果明显受损。
与传统钢板和螺钉相比，解剖预成型 LCP 能更充分地防止关节面下骨折块沉降，并改善患者预后。因此，对于外侧胫骨平台劈裂凹陷骨折，应仔细考虑使用解剖预成型 LCP 进行内固定。
