Treatment of tibial plateau fractures: A comparison of two different operation strategies with medium-term follow up,Journal of Orthopaedic Translation

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Treatment of tibial plateau fractures: A comparison of two different operation strategies with medium-term follow up
Journal of Orthopaedic Translation ( IF 6.6 ) Pub Date : 2022-07-09 , DOI: 10.1016/j.jot.2022.06.005
Zhongzheng Wang _{1,

2} , Zhanle Zheng _{1,

2,

3} , Pengyu Ye _{1,

2} , Siyu Tian _{1,

2} , Yanbin Zhu _{1,

2,

3} , Wei Chen _{1,

2,

3} , Zhiyong Hou _{1,

2,

3} , Qi Zhang _{1,

2,

3} , Yingze Zhang _{1,

2,

3,

4}

Affiliation

Background

The objective of this study was to compare the clinical and radiological outcomes of two surgical methods for tibial plateau fractures (TPFs): minimally invasive surgery (MIS) using a double reverse traction repositor and traditional open reduction internal fixation (ORIF).

Methods

From our prospectively collated database, 187 consecutive adult patients with 189 operatively treated TPFs in our level I trauma center were included from January 2015 to March 2018 who had a minimum of three years’ follow-up. All cases were performed by the senior surgeon using either MIS (group 1, 84 patients with 84 TPFs) or ORIF (group 2, 103 patients with 105 TPFs). Details of the demographics, injury mechanism, pre- and postoperative follow-up imaging, operative procedures and complications were collected. The final results from the 36-Item Short-Form Health Survey (SF-36), Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Hospital for Special Surgery (HSS) were obtained at the final follow-up.

Results

Clinically, significant differences were observed in the WOMAC (pain, P = 0.001; stiffness, P < 0.001), HSS (P = 0.003) and SF-36 (P = 0.001). Radiologically, significant intergroup differences were observed in the loss of immediate postoperative reduction rates, secondary loss of reduction rates and signs of osteoarthritis (Kellgren–Lawrence). Two and ten superficial infections in group 1 (2.4%) and group 2 (9.5%), respectively, and 6 lateral popliteal nerve palsy cases occurred (0 MIS, 6 ORIF), with significant intergroup differences.

Conclusion

Our study shows that the MIS using a double reverse traction repositor is promising and safe technique for the TPFs when used for the correct indications.

The translational potential of this article

The current status of using a minimally invasive surgery for the treatment of TPFs have been analyzed and a new method of using a double reverse traction repositor for the treatment of TPFs have been proposed in this study, which updated treatment concept of TPFs.

中文翻译：

胫骨平台骨折的治疗：两种不同手术策略的中期随访比较

背景

本研究的目的是比较两种胫骨平台骨折 (TPF) 手术方法的临床和放射学结果：使用双反向牵引储存器的微创手术 (MIS) 和传统的切开复位内固定 (ORIF)。

方法

从我们前瞻性整理的数据库中，我们纳入了 2015 年 1 月至 2018 年 3 月在我们的 I 级创伤中心接受手术治疗的 189 例 TPF 的 187 名成年患者，他们至少进行了三年的随访。所有病例均由资深外科医生使用 MIS（第 1 组，84 名患者，有 84 个 TPF）或 ORIF（第 2 组，103 名患者，有 105 个 TPF）进行。收集人口统计学、损伤机制、术前和术后随访影像学、手术程序和并发症的详细信息。最终随访时获得了 36 项简短健康调查 (SF-36)、西安大略和麦克马斯特大学骨关节炎指数 (WOMAC) 和特殊外科医院 (HSS) 的最终结果。

结果

临床上，WOMAC（疼痛， P =0.001；僵硬，P <0.001）、HSS（P =0.003）和 SF-36（P =0.001）观察到显着差异。在放射学上，在术后即刻复位率的丧失、继发性复位率的丧失和骨关节炎的迹象 (Kellgren-Lawrence) 方面观察到显着的组间差异。第 1 组（2.4%）和第 2 组（9.5%）分别发生 2 例和 10 例浅表感染，发生了 6 例腘外侧神经麻痹病例（0 MIS，6 ORIF），组间差异显着。