Department of Orthopaedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, University of Florida, PO Box 112727, Gainesville, FL, 32608, USA.
Eur J Orthop Surg Traumatol. 2023 Jul;33(5):1653-1661. doi: 10.1007/s00590-022-03326-8. Epub 2022 Jul 8.
Outcomes data of intramedullary nail fixation (IMN) constructs for complex Schatzker VI tibial plateau fractures are scant in the literature. This study compares the clinical and radiographic outcomes of IMN, dual plate, and single plate constructs for Schatzker IV tibial plateau fractures.
Retrospective cohort study of sixty-two patients at a University-based Level 1 trauma center who underwent open reduction internal fixation for Schatzker VI tibial plateau fracture. Constructs evaluated were IMN (with or without raft screws), dual plating, and single plating. Demographic, clinical, and radiographic outcomes were recorded. All fractures were additionally classified based on the OTA classification for sub analyses. Mean follow-up was 13.2 (SD 13.3) months. Predictors of construct selection and outcomes were evaluated with bivariate logistic regression. Outcomes were compared between groups with independent samples t-tests and Chi Square tests.
No significant demographic differences were found between IMN, dual plate or single plate construct cohorts. There was a higher proportion of open fractures within the IMN construct group versus the dual plate cohort (21.1% vs 3.6%). No statistically significant differences in radiographic outcomes were observed between cohort groups except for small but statistically significant differences in condylar width (CW) ratio change and tibial slope; when fracture cohorts were sub analyzed by specific OTA classification, there were no significant differences in any radiographic outcomes. There was a significant difference between the ratio of OTA 41C1, C2 and C3 fractures regarding treatment allocation (p = 0.004), favoring dual plate fixation for OTA 41C3 fractures. There were no significant differences found between treatment cohorts in terms of all cause complications (p > 0.05). IMN and single plate constructs were utilized when posteromedial condyle fractures were nondisplaced or minimally displaced.
Intramedullary nail fixation with or without supplemental raft screws produced similar short-term clinical and radiographic results compared to dual and single plate constructs among patients with Schatzker VI fracture types, regardless of OTA classification. Level of Evidence Level III retrospective cohort.
在文献中，针对复杂 Schatzker VI 胫骨平台骨折的髓内钉固定（IMN）结构的结果数据很少。本研究比较了 IMN、双板和单板结构治疗 Schatzker IV 胫骨平台骨折的临床和影像学结果。
对一家大学一级创伤中心的 62 例患者进行回顾性队列研究，这些患者接受了切开复位内固定治疗 Schatzker VI 胫骨平台骨折。评估的结构包括 IMN（带或不带筏螺钉）、双板和单板。记录了人口统计学、临床和影像学结果。所有骨折均根据 OTA 分类进行亚分析。平均随访 13.2（SD 13.3）个月。使用双变量逻辑回归评估结构选择和结果的预测因素。通过独立样本 t 检验和卡方检验比较组间的结果。
IMN、双板或单板结构组之间没有发现显著的人口统计学差异。IMN 结构组的开放性骨折比例高于双板组（21.1%比 3.6%）。除了髁间宽度（CW）比值变化和胫骨斜率的小但统计学显著差异外，各组之间的影像学结果没有统计学显著差异；当根据特定的 OTA 分类对骨折组进行亚分析时，任何影像学结果均无显著差异。OTA 41C1、C2 和 C3 骨折的治疗分配之间存在显著差异（p=0.004），有利于 OTA 41C3 骨折的双板固定。在所有原因并发症方面，治疗组之间没有发现显著差异（p>0.05）。当后内侧髁骨折无移位或轻度移位时，使用髓内钉固定或附加筏螺钉。
对于 Schatzker VI 骨折类型的患者，无论 OTA 分类如何，IMN 固定加或不加辅助筏螺钉与双板和单板结构相比，产生了类似的短期临床和影像学结果。证据水平 III 级回顾性队列。
