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Tibial plateau fracture cases & Clinical assessment

Abstract:Objective: To investigate the interrelated factors for the operation effect of using steel plate internal fixation to restore the tibial plateau fracture. Method: 34 patients with tibial plateau fracture were operated by using steel plate internal fixation one or two side, restored the tibial plateau anatomical structure, firmly fixation, and took early function exercise post-operation. Result: All patients were followed up for 4-36 months, average 15 months, according to the Rasmussen score, 21 patients were in excellent,8 in good,3 in approve,2 in poor. The excellent ratio was 85.3%. Conclusion: Grasp appropriate operation opportunities, use correct means and take earlier function exercises, afford us excellent operation effects in treating tibial plateau fracture. 
 
1.1 General Information: this group had 34 patients with 26 males and 8 females. The patients were aged 27 to 72 with average age of 39.6. There were 20 cases of traffic accidents injuries, 11 cases of falling injuries and 3 cases of heavy crushing. All cases were closed fractures without vascular injuries. There were 3 cases of cruciate ligament injures, 4 cases of collateral ligament injuries and 4 cases of meniscus injuries. Fractures were classified in accordance with Schatzker: 8 cases of I type, 12 cases of II type, 5 cases of III type, 2 cases of IV type, 4 cases of V type and 3 cases of VI type. All patients were examined by X-ray, CT scan of the tibial plateau and three-dimensional reconstruction, and some patients were examined by MR. Besides, the operation time was 7~21d after injury, average 10d. Of this, there were 30 patients accepting the bone grafting treatment, 3 patients accepting double plate fixation, and the rest patients accepting the unilateral internal fixation. 
 
1.2 Surgical Method: conducted spinal anesthesia or intubation anesthesia, the patient were in supine position, and operated under pneumatic tourniquet. The surgery used the anterolateral knee, anterior tibial or lateral knee joint posterior incision. Coronary ligament was incised along the Incision along the lower edge of meniscus, and exposed the articular surface of the tibial plateau. Reduce the plateau fractures under direct vision. Some bones were first fixed with Kirschner pins, and then fixed by the appropriate plates (golf-plate, L-plates, T-plate, or combined with medial buttress plate). The bone defects were filled with allogenic bone (early) and allograft bone grafting. In the operation, the surgeon realized the anatomical reduction and proximal anatomical reduction, maintained normal tibial axis, firm internal fixation, compacted bone graft and accurate support. Probed the knee ligament and meniscus for the preoperative diagnosis or intra-operative suspected cases, and made the appropriate repair process.
 
1.3 Postoperative Treatment: the postoperative limb elastic bandage should be bandaged properly, and late incision was inserted with drainage tube, which should be unplugged at 48h. Routine postoperative analgesia. The patients took limb muscle exercises after 24h, and took CPM exercises after removing the drainage tube for the simple fractures. Combined the collateral ligament, posterior cruciate ligament injury cases, actively and passively moved the knee after fixing the plaster or brace for one month. According to X-ray examination results, the surgeon guided patients to gradually take limb weight-loading exercises, and full weight loading should be made at least four months later.