Surgical approaches for treatment of tibial plateau fractures with posterior condylar involved

Objective To investigate surgical outcomes of the fracture of tibial plateau with the posterior condylar involved of17 patients, which were classified by three columns theory of tibial plateau fractures, and thus design appropriate surgical approaches to reduce and treat the corresponding fractures. Methods The L incision behind the knee joint was chosen to treat the fractures of tibial plateau which were the simple posterior column fractures of tibial plateau or combined with medial column fractures of tibial plateau while the L incision behind the knee joint and anterolateral incision of the knee joint were used to treat the fractures of tibial plateau which were the posterior column fractures of tibial plateau combined with lateral column or combined with lateral and medial column fractures of tibial plateau. The knee X-ray was regularly used to observe the fracture healing and measure the varus angle and the inclination angle of the tibial plateau postoperatively. Rasmussen method of the knee function score was used to evaluate the efficacy of postoperative. Results Seventeen patients were followed up for more than 1 year, average 13.7 months, all tibial plateau fractures were healed, with no one case of infection,skin necrosis or internal fixation loosening of fracture. There were no significant difference(t =-0.911,P =0.376) in the Varus angle of tibial plateau between 1 year after surgery(86.39±0.32)° and immediately after operation(86.27±0.35)°, in addition,there was also no significant difference(t =0.557,P =0.585) in the inclination angle of tibial plateau between 1 year after surgery(9.17±0.34)° and immediately after operation(9.15±0.34)°. Graded with Rasmussen method of the knee function score at 1 year after surgery,the outcome was excellent in 9 cases, good in 7 cases, fair in 1 case, and the excellent and good rate was 94.1%. Conclusion Three column classification theory of tibial plateau is a significant guide in the design of surgical approaches for the treatment of tibial plateau fractures with the posterior condylar involved, but it may need to further subdivide fracture subtypes in the design of surgical approach for the treatment of the posterior condylar of tibial plateau fractures combined with lateral condyle fracture type.