Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Department of Surgery, Aga Khan University Hospital, Karachi.
J Pak Med Assoc. 2023 May;73(5):1087-1090. doi: 10.47391/JPMA.1566.
Displaced Tibiai plateau fractures are complex periarticular injuries. Restoration of the anatomy and internal fixation are key elements for early return to function and better functional outcome. Newer modalities like CT scans has enabled better understanding of these fractures. Posterior approaches were not very common as compared to anteromedial and anterolateral surgical approach. Posterior approach has the advantage of avoiding anterior skin and soft tissues that has been compromised as a result of the fracture; it is also particularly helpful in direct and accurate reduction in certain fracture patterns. This case series highlights the importance of posterior approach to restore the articular surface of complex periarticular proximal Tibial fractures. All displaced tibial plateau fractures with posteromedial fragment were included in the study. Pathological fractures and all open fractures were excluded from this study. Oxford Knee score was done at regular intervals for functional outcome assessment. No wound complications or iatrogenic neurovascular damage were observed with this approach in this series. Anatomical reduction and radiological union was obtained in all patients with excellent functional outcome. We recommend posterior Lobenhoffer approach for fixation in select group of patients with Tibial plateau fractures.
胫骨平台骨折是一种复杂的关节周围损伤。恢复解剖结构和内固定是早期恢复功能和更好功能结果的关键因素。像 CT 扫描这样的新技术使我们能够更好地理解这些骨折。与前内侧和前外侧手术入路相比，后入路并不常见。后入路的优点是避免了由于骨折而受损的前侧皮肤和软组织；对于某些骨折模式，它还特别有助于直接和准确地复位。本病例系列强调了后入路在恢复复杂关节周围胫骨近端骨折关节面方面的重要性。本研究纳入所有有后内侧骨折块的移位胫骨平台骨折。排除病理性骨折和所有开放性骨折。定期进行牛津膝关节评分以评估功能结果。在本系列中，这种方法没有观察到伤口并发症或医源性神经血管损伤。所有患者均获得解剖复位和影像学愈合，功能结果良好。我们建议对选择的胫骨平台骨折患者采用后 Lobenh oeffer 入路进行固定。
