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Lateral locking plate plus antero-posterior lag screws techniques for the management of posterolateral tibial plateau fracture: preliminary clinical results and biomechanical study

  • Trauma Surgery
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Abstract

Introduction

To date, there is no consensus on the optimal surgical strategy for the treatment of posterolateral tibial plateau fracture (PLF). This study introduced a novel, simple technique for treating PLF with a lateral locking plate plus antero-posterior lag screws (LPpLS).

Methods

We conducted a retrospective case series of 42 patients (Female/Male 19/23) with PLF treated with LPpLS between 1 July 2016 and 30 June 2019. Several pre- and postoperative outcomes were recorded, including operative time, intraoperative blood loss, CT findings, HSS, and ROM. For biomechanical studies, seventy synthetic tibiae with a simulated posterolateral split fracture were divided into seven groups. The biomechanical evaluation included displacement measurement at axial compression and fatigue testing.

Results

Forty-two eligible patients were followed up for an average of 18 months (range 14–21 months). Postoperative radiographs and CT showed good positioning of plates and screws, no fracture fragment loss, and normal articular surfaces in all 42 cases. The biomechanical study showed that the axial stiffness of LPpLS was in the same fashion as the posterior buttress plate and better than the other fixation methods (P < 0.05). Additionally, the LPpLS group had a smaller displacement of fracture fragments along the X-axis (medial to lateral direction) than the BP group (P < 0.01).

Conclusions

The LPpLS technique could implement good reconstruction of the PLF, showing satisfactory therapeutic effect. The biomechanical evaluation demonstrated that the LPpLS had better stability in three-dimensional directions for PLF than other fixation strategies.

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Funding

This research has been funded by the China National Key R&D Program (Grant No. 2020YFF0304703) and the Knowledge Innovation Special Project of Hubei Province of China (2016CFB420).

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Author notes

  1. Weihang Gao and **angbei Qi have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Orthopaedics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China

    Weihang Gao & ** Liu

  2. Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China

    **angbei Qi

  3. Department of Orthopaedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (originally named Shanghai First People’s Hospital), Shanghai, People’s Republic of China

    Ke Zhao, Yuehua Yang & Dehao Fu

  4. Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China

    **aobo Feng

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The Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (IORG No: IORG0003571) gave final approval.

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Gao, W., Qi, X., Zhao, K. et al. Lateral locking plate plus antero-posterior lag screws techniques for the management of posterolateral tibial plateau fracture: preliminary clinical results and biomechanical study. Arch Orthop Trauma Surg 143, 3163–3172 (2023). https://doi.org/10.1007/s00402-022-04554-7

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