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AN IMPROVED REDUCTION TECHNIQUE FOR DEPRESSION FRACTURES OF LATERAL TIBIAL PLATEAU

WANG Hongchuan,LOU Hua,LIU Kai,JIANG Junwei.Department of Orthopedics,People's Hospital of Leshan,Leshan Sichuan,614000,P.R.China.  
Objective To investigate the improved reduction technique for depression fractures of the lateral tibial plateau and its effectiveness.Methods Between January 2008 and December 2010,48 patients(48 knees) with depression fractures of the lateral tibial plateau(Schatzker Ⅱ or Ⅲ fractures) were treated.There were 32 males and 16 females with an average age of 45.8 years(range,16-79 years).All fractures were fresh closed fractures,which were caused by traffic accident in 27 cases,by falling from height in 5 cases,by crushing in 8 cases,and by sustained falls in 8 cases.According to Schatzker classification,29 cases were classified as type Ⅱ and 19 cases as type Ⅲ.The lateral cortex was cut off to expose the depression and compacted cancellous bone was elevated to reset the articular surface.After reduction,autologous iliac bone graft and locking plate internal fixation were used.Results Healing of incision by first intention was achieved in all patients,and no complication occurred.All patients were followed up 1.7 years on average(range,1-3 years).At last follow-up,the knee extension was(—0.5± 0.3)°,and the knee flexion was(136.9 ± 8.8)°.X-ray films showed that the fracture healing time was 52 weeks and no breakage of internal fixation occurred.According to Rasmussen clinical score,the results were excellent in 35 cases,good in 10 cases,and fair in 3 cases.According to Rasmussen radiographical score,the results were excellent in 41 cases,good in 7 cases;there were 41 excellent scores and 7 good scores of articular reduction;all gained good recovery of coronal and sagittal alignment and condylar width.The articular surface collapse was(1.0 ± 0.7)mm at immediate postoperatively and(1.2 ± 0.7) mm at last follow-up,showing no significant difference(t=—1.42,P=0.20),but significant differences were found when compared with that at preoperation [(12.2 ± 8.0) mm,P 0.05].Conclusion This improved technique can provide a satisfactory effectiveness of fracture reduction and can avoid loss of reduction.The short-term effectiveness is good,but futher follow-up is necessary to determine the long-term results.
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