Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia.
Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Int Orthop. 2023 Aug;47(8):2073-2083. doi: 10.1007/s00264-023-05849-z. Epub 2023 Jun 8.
Lateral tibial plateau fractures with depression are the most common. Their treatment is currently surgical. Many therapeutic procedures have been described. Our aim is to evaluate the results of open surgery and to compare the two internal fixation methods used: lag screw versus plates.
This is a retrospective comparative study of two series of tibial plateau fractures Schatzker types II and III treated surgically over a period of ten years with two different methods: Group A: Internal fixation using screws for 86 patients. Group B: Internal fixation using plates for 71 patients. Functional and anatomical results were assessed according to Rasmussen's clinical and radiological scores.
The patients' average age was 44 years (range from 18 to 76). The male gender was predominant (104 males and 53 females). Road traffic accidents were the most common aetiology with over two thirds of the cases. The fractures were type Schatzker II in 61% of the cases. The mean follow-up was five years. Although the clinical and radiological Rasmussen scores were better in group A (internal fixation with lag screws), those differences were statistically insignificant (p = 0.6 and p = 0.8). Group A clinical and radiological scores were 26.06 and 16.57, respectively and those of group B were 25.72 and 16.45. We noticed more sepsis and skin complications and a longer operating time (95 min versus 70 min) in group B patients with a statistically significant difference. None of the patients of our series had bone grafting.
For Schatzker II and III fractures, an internal fixation with lag screws would be preferable when possible especially in the case of a pure depression fracture. It yields satisfactory results with a shorter operating time and less complication rate.
外侧胫骨平台伴凹陷骨折最为常见。目前其治疗方法为手术。有许多治疗方法已被描述。我们的目的是评估开放式手术的结果，并比较两种内部固定方法：拉力螺钉与钢板。
这是一项回顾性比较研究，对两个系列的胫骨平台骨折 Schatzker Ⅱ型和Ⅲ型进行了手术治疗，使用了两种不同的方法：A 组：使用螺钉固定 86 例患者。B 组：使用钢板固定 71 例患者。根据 Rasmussen 的临床和影像学评分评估功能和解剖结果。
患者的平均年龄为 44 岁（范围 18-76 岁）。男性居多（104 例男性，53 例女性）。道路交通伤是最常见的病因，超过三分之二的病例是这种病因。骨折类型 Schatzker Ⅱ型占 61%。平均随访时间为 5 年。尽管 A 组（使用拉力螺钉固定）的临床和影像学 Rasmussen 评分更好，但这些差异无统计学意义（p=0.6 和 p=0.8）。A 组的临床和影像学评分分别为 26.06 和 16.57，B 组分别为 25.72 和 16.45。我们注意到 B 组患者的感染和皮肤并发症更多，手术时间更长（95 分钟对 70 分钟），且差异有统计学意义。我们系列中的所有患者均未进行植骨。
对于 Schatzker Ⅱ型和Ⅲ型骨折，在可能的情况下，使用拉力螺钉内固定尤其在单纯凹陷骨折的情况下会更好。它的手术时间更短，并发症发生率更低，结果令人满意。
