Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.
Department of Orthopedics and Traumatology, VU Brussel-Free University of Brussels, Brussels, Belgium.
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1285-1294. doi: 10.1007/s00068-021-01639-7. Epub 2021 Mar 12.
Operative management of posterior tibial plateau fractures (PTPF) remains challenging. The treatment goal is to restore the alignment and articular congruence, and providing sufficient stability which allows early mobilization. The purpose of this study was to assess the feasibility and safety of the newly developed WAVE posterior proximal tibia plate.
Between Oct 2017 and Jun 2020, 30 adult patients with a tibial plateau fracture and posterior involvement were selected for treatment with a WAVE posterior proximal tibia plate. Patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at time of injury (pre-injury) and at 1-year follow-up. Radiological outcome was evaluated with CT-imaging.
Twenty-eight patients were eligible for treatment with the new implant (3 'one-column', 10 'two column' and 15 'three-column' fractures), whereas in 2 patients anatomical fit was insufficient. KOOS results showed fair outcome scores at 1 year, with a large negative impact compared to pre-injury levels; however, a trend towards better results compared to a previous PTPF reference cohort. Radiological follow-up showed insufficient posterolateral buttress in two cases and residual articular step-off (> 2 mm) in seven patients, of which five were classified as three column fractures.
Management of PTPF using the WAVE posterior proximal tibia plate is feasible and safe with satisfactory clinical and radiological results after 1 year. Nevertheless, there is a learning curve regarding optimal implant positioning to achieve the maximum benefit of the implant.
胫骨平台后骨折（PTPF）的手术治疗仍然具有挑战性。治疗目标是恢复对线和关节面的一致性，并提供足够的稳定性，以允许早期活动。本研究的目的是评估新型 WAVE 胫骨近端后钢板的可行性和安全性。
在 2017 年 10 月至 2020 年 6 月期间，选择 30 例胫骨平台骨折伴后柱受累的成人患者，采用 WAVE 胫骨近端后钢板治疗。采用膝关节损伤和骨关节炎评分（KOOS）评估患者报告的结果，分别在受伤时（受伤前）和 1 年随访时进行评估。通过 CT 成像评估放射学结果。
28 例患者适合使用新植入物治疗（3 例“单柱骨折”，10 例“双柱骨折”和 15 例“三柱骨折”），而 2 例患者解剖结构不适合。KOOS 结果显示，1 年后的结果评分一般，与受伤前水平相比有较大的负面影响；然而，与以前的 PTPF 参考队列相比，有改善的趋势。放射学随访显示，有 2 例存在后外侧壁支撑不足，7 例存在残余关节台阶（>2mm），其中 5 例为三柱骨折。
使用 WAVE 胫骨近端后钢板治疗 PTPF 是可行和安全的，1 年后的临床和放射学结果令人满意。然而，为了获得植入物的最大效益，存在一个关于最佳植入物定位的学习曲线。
