A new strategy to fix posterolateral depression in tibial plateau fractures: Introduction of a new modified Frosch approach and a "Barrel hoop plate" technique. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Yi, Zhu; Hui, Sun; Binbin, Zhang; Jianfei, Tang; Huipeng, Shi; Jiong, Mei; Congfeng, Luo
• Is Part Of: Injury. Volume 51:Issue 3(2020)
• Page Start: 723
• Page End: 734
• Publication Date: 2020-03
• Subjects: Tibial plateau fracture -- Posterolateral depression -- Fixation -- Approach; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.01.023
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Bony reconstruction of posterolateral depression: This paper introduced a new technique which will be helpful for the majority of trauma surgeons. As far as we know, the articular congruity of tibial plateau has been stressed to be associated with the long-term function outcomes. In this paper, a new technique was developed in order to effectively reconstruct the posterolateral depression anatomically. Accordingly, the reduction techniques we introduced was also applicable for the surgeons. "Barrel hoop plate": We firstly developed this concept which is suitable in tibial plateau fracture involved in a rim rupture. Firstly, the plate can hoop the plateau barrel and reconstruct the PL plateau. Secondly, all the screws of the "Barrel hoop plate" can be inserted to crosswise hold the subchondral bone of PL depression, acting as a raft. A modified Frosch approach: The fixation strategey is achieved via a modified Frosch approach which is another innovation of our study. Abstract: Aims: The articular congruity of tibial plateau has been stressed to be associated with the long-term function outcomes. Approach selection and fixation pattern to manipulate the posterolateral (PL)-depression of tibial plateau are both key issues which trauma surgeons should focus on. In order to provide a strong purchase of PL-depression, we developed a new modified Frosch approach and a "Barrel hoop plate" technique to provide bony reconstruction of PL-depression. Materials and methods: Eleven consecutive patients of tibial plateau fractures involved in PL-depression were surgically treated at our single level-I trauma center. Our newly designed "Barrel hoop plate" was used to fix the PL-depression via a modified Frosch approach. The demography and treatment information were summarized of all the patients. X-ray and CT-scan of the knee joint were used to assess the reduction after operation. Besides evaluation of the HSS knee score, medial tibial plateau angle(mTPA), posterior slope angle(PSA) and articular step-off were measured to assess the malreduction degrees. Results: The average operation time was 123 ± 20 min. The mean blood loss was 148 ± 45 mL. The fractures were healed radiographically at 13 ± 1 weeks post-operation. After 15 ± 2 months follow-up, all the patients were pain-free with full range of motion and stable knees. Radiologically, good fracture reduction was achieved in all cases. According to the final assessment, the mTPA, m-PSA and l-PSA were 85° ± 2°, 11° ± 5° and 10° ± 6°, respectively. The average range of motion was 128° ± 10°in flexion and 4° ± 4° in extension, and the average HSS score was 91 ± 3. Conclusion: Our new approach is a modification of the Frosch approach with a decreased soft tissue exposure and a low risk of neurovascular vessel injury. The concurrent application of the "Barrel hoop plate" technique could not only provide a reconstruction of the PL tibial plateau, but also hoop the ruptured tibia plateau rim and secure the depression as a raft. This new technique prevented the PL-tibial plateau reduction loss and the made the patients' early range of motion come true.