The clinical observation of posteromedial and posterolateral approaches in the treatment of posterior shearing tibial plateau fractures

[Objective]To investigate the clinical effect of posteromedial and posterolateral approaches in the treatment of posterior shearing tibial plateau fractures and provide the reference for the clinics.[Method]A retrospective analysis of 46 patients with posterior shearing tibial plateau fractures from Jan 2009 to Apr 2012 in our hospital were included in this study.All the patients were treated by posteromedial and posterolateral approaches.Posteromedial approach was made through the interval of semitendinosus,semimem branosus and the medial head of gastrocnemius,posterolateral approach was made through the gap of popliteus and soleus,a T shape buttress plate was used to fixe the posteromedial or posterolateral fragment which was visibly reduced.All the patients were followed up,the fixation and clinical effect were observed after operation.[Result]All cases were followed up for 12-32 months with an average of( 22 ± 0.3) months.There was no complication such as necrosis of skin incision,infection,loosening and breakage of internal fixators during the follow-up period.Radiographic assessment:there was no significant difference between tibial plateau angle and posterior slope angle immediately and one year after operation( P 0.05).The average HSS score at the final follow-up was 87.6.The clinical outcomes were determined using Rasmussen criteria,which revealed that 27( 58.7%) patients had excellent result,13( 28.3%) good and 6( 13.0%) fair.[Conclusion]The advantages of posteromedial and posterolateral approaches include reduction of articular surface under visualization,firm fixation,less complications,and earlier functional exercise,so it is an ideal surgical treatment plan for posterior shearing tibial plateau fractures.