Fahlbusch Hendrik, Behrendt P, Becker A, Arras C, Gablac H, Frings J, Hoffmann M, Krause M, Frosch K H
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
J Orthop Surg Res. 2025 Apr 10;20(1):363. doi: 10.1186/s13018-025-05775-3.
This study evaluated the clinical and radiological outcomes of lateral tibial plateau fractures involving the central and postero-lateral regions, comparing an extended lateral approach with lateral epicondyle osteotomy (ECO) to a conventional approach without an extention (No-ECO).
A retrospective cohort study was conducted at two centers, examining complex lateral tibial plateau fractures treated with either an extended lateral approach with ECO or without it. Only AO/OTA type B3/C3 fractures involving the antero-latero-central (ALC) and postero-latero-central (PLC) segments were included. Fracture reduction quality was assessed via post-operative CT scans, and clinical outcomes and complications were evaluated over a minimum of 24-month follow-up.
A total of 110 patients (mean age: 51.3 ± 11.1 years) were included, with an average follow-up of 52.7 ± 16.9 months. The ECO group (n = 56) consisted of more severe injuries, indicated by higher external fixator use (48.2% vs. 22.2%, p = 0.0044) and additional affected segments. Postoperative CT scans revealed that the ECO group had significantly less fracture step-off (0.8 mm vs. 3.0 mm, p = 0.0002) and angulation at the ALC/PLC (8.1° vs. 20.1°, p = 0.0002) segment and PLC/PLL (postero-latero-lateral) (2.2° vs. 7.5°, p = 0.02) segments. Clinically, the ECO group achieved superior IKDC scores (71.7 vs. 63.7, p = 0.0097). A negative correlation was found between postoperative ALC/PLC depression and IKDC scores (r=-0.36, p = 0.0002).
Patients treated with ECO had a significantly better clinical and radiologic postoperative outcomes, with the quality of fracture reduction positively correlating with the clinical IKDC score. This was achieved despite more severe injuries, as indicated by higher external fixator use and number of affected segments.
III Retrospective Cohort Study.
The study was retrospectively registered and conducted according to the guidelines of the Declaration of Helsinki and approved by the local Ethics Committee (PV7319).
本研究评估了累及胫骨平台中央和后外侧区域的外侧胫骨平台骨折的临床和影像学结果，比较了采用外侧上髁截骨术（ECO）的延长外侧入路与未采用延长入路（非ECO）的传统入路。
在两个中心进行了一项回顾性队列研究，检查采用带ECO或不带ECO的延长外侧入路治疗的复杂外侧胫骨平台骨折。仅纳入累及前外侧中央（ALC）和后外侧中央（PLC）节段的AO/OTA B3/C3型骨折。通过术后CT扫描评估骨折复位质量，并在至少24个月的随访期内评估临床结果和并发症。
共纳入110例患者（平均年龄：51.3±11.1岁），平均随访52.7±16.9个月。ECO组（n=56）损伤更严重，外固定架使用率更高（48.2%对22.2%，p=0.0044）以及更多的受累节段表明了这一点。术后CT扫描显示，ECO组在ALC/PLC节段（0.8mm对3.0mm，p=0.0002）和PLC/PLL（后外侧）节段（2.2°对7.5°，p=0.02）的骨折台阶和成角明显更小。临床上，ECO组获得了更高的国际膝关节文献委员会（IKDC）评分（71.7对63.7，p=0.0097）。术后ALC/PLC凹陷与IKDC评分之间存在负相关（r=-0.36，p=0.0002）。
采用ECO治疗的患者术后临床和影像学结果明显更好，骨折复位质量与临床IKDC评分呈正相关。尽管外固定架使用率更高和受累节段数量更多表明损伤更严重，但仍取得了这样的结果。
III级回顾性队列研究。
该研究根据《赫尔辛基宣言》的指导原则进行回顾性注册并开展，并获得当地伦理委员会（PV7319）的批准。
