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Reverse traction with Kirschner wires and bilateral external fixation device combined with minimally invasive plate oseoynthesis technique for tibial plateau fractures of type Schatzker V and VI

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Abstract

Purpose

Complex bicondylar tibial plateau fracture (TPF) has always been a tricky problem for surgeons. We created a novel external device used intraoperatively consisting of Kirschner wires, and combined with minimally invasive plate oseoynthesis (MIPO) technique to treat complex bicondylar TPFs, and the clinical effect and feasibility were further evaluated.

Methods

From March 2016 to February 2021, 49 cases (29 males and 20 females) were identified as bicondylar TPF, the mean age 47.2 (27–69). All patients adopted the device and MIPO technique. A series of score, complications, and radiographs in the follow-up period, from three months, six months, one year, and two years and the last follow-up, were recorded, from visual analogue score (VAS), hospital for special surgery (HSS), and Short-Form 36 (SF-36), containing physical (PCS) and mental (MCS), and Rasmussen score.

Results

Forty-seven patients showed good functional recovery. No patients were lost, mean follow-up time was 28.17 ± 2.81 (24.2–35.4) months. Operation time was 89.80 ± 13.46 (58–110) min. At the last follow-up, VAS was 1.3 ± 0.92 (0–4), HHS was 93.10 ± 2.63 (89–99), PCS was 49.20 ± 7.40 (38–65), and MCS was 50.08 ± 4.77 (43–62). Complications were as follows: cutaneous necrosis (3, 6%), asymptomatic arthritis (3, 6%), symptomatic arthritis (1, 2%), and deep venous thrombosis (1, 2%). Mean fracture healing time was 11.82 ± 1.5 (10–15.4) weeks. All patients got recovery without extra surgery and removed the implants at 12.85 ± 0.76 (11.2–15.4) months.

Conclusion

Temporary traction device of bilateral external fixator combined with MIPO technique was simple and convenient, with a smaller soft-tissue damage, an easier operational approach, and its worth being promoted.

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Funding

This study received financial support from Zhejiang Traditional Chinese Medicine Administration (2020ZB090), and Hua Jiang Famous Expert Inheritance Studio of Traditional Chinese Medicine (GZS2021020).

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Author notes

  1. Wei-Qiang Zhao and Xu-Song Li contributed equally to this study.

Authors and Affiliations

  1. Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China

    Wei-Qiang Zhao, Jiang Hua & Jie-Feng Huang

  2. The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China

    Wei-Qiang Zhao, Jiang Hua & Jie-Feng Huang

  3. Department of Orthopaedics & Traumatology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528401, Guangdong, China

    Xu-Song Li

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  1. Wei-Qiang Zhao
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  4. Jie-Feng Huang
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Contributions

Wei-Qiang Zhao: wrote the text, prepared the figures, collected and analyzed the data, approved the final version for submission.

Xu-Song Li: designed the study, analyzed the data, and approved the final version for submission.

Jiang Hua: collected and analyzed the data, approved the final version for submission.

Jie-Feng Huang: designed the study, wrote the text, prepared the figures, approved the final version for submission.

Corresponding authors

Correspondence to Jiang Hua or Jie-Feng Huang.

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Zhao, WQ., Li, XS., Hua, J. et al. Reverse traction with Kirschner wires and bilateral external fixation device combined with minimally invasive plate oseoynthesis technique for tibial plateau fractures of type Schatzker V and VI. International Orthopaedics (SICOT) 47, 2327–2336 (2023). https://doi.org/10.1007/s00264-023-05877-9

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