Abstract:

BACKGROUND: Simple posterolateral tibial plateau collapse fracture is very rare in the clinic. The displaced collapse fracture in this area must be anatomically reduced, filled with suitable materials, and fixed with internal fixators.

OBJECTIVE: To evaluate the stability, clinical results and biocompatibility of modified posterolateral approach to treat simple posterolateral tibial plateau collapse fracture with beta-tricalcium phosphate combined with T-shaped locking plate.

METHODS: Fifteen patients with simple posterolateral tibial plateau collapse fractures who received surgical treatment between June 2013 and December 2017 in Zhangjiagang Hospital Affiliated to Soochow University. These patients included 8 males and 7 females, aged 25-53 years. All of them received surgical treatment with beta-tricalcium phosphate combined with T-shaped locking plate through the modified posterolateral approach. After surgery, they were followed up for 12 months. X-ray examination was performed to evaluate fracture healing and internal fixation. Reduction effect was evaluated by Rasmussen radiology score. Knee function and stability were evaluated by HSS knee function score, Lachman test, pivot-shift test and lateral stress test. This study was approved by Medical Ethics Committee, Zhangjiagang Hospital Affiliated to Soochow University, China (approval No. 201305KS001).

RESULTS AND CONCLUSION: (1) All patients underwent anatomical reduction of knee fractures, and the fracture healing time was 9-14 weeks. At 12 months after surgery, β-tricalcium phosphate was completely absorbed and replaced by new bone, and repair of bone defect was satisfactory. (2) There were no significant differences in posterior tibia angle, varus angle, Rasmussen imaging collapse score and Rasmussen imaging total score between 12 months after surgery and immediately after surgery in 15 patients (P > 0.05). (3) At 12 months after surgery, the HSS score of the knee joint was 89-100, and Lachman test, pivot-shift test and lateral stress test results were negative in 15 patients. (4) During the follow up period, infection around implants, allergic reaction, immune reaction, or rejection reaction was not observed. (5) These findings suggest that treatment of simple posterolateral tibial plateau collapse fracture through the modified posterolateral approach with β-tricalcium phosphate combined with T-shaped locking plate exhibits good repair effects and biocompatibility. 

Key words: orthopedic implant, tibial factures, posterolateral approach, beta-tricalcium phosphate, bone graft, locking plate, internal fixation of fracture, posterolateral tibial plateau fracture