[Exploration of surgical approaches of complex tibial plateau fractures]

To evaluate the surgical treatment and its results of complex tibial plateau fractures.

From May 2003 to November 2004, 24 cases of complex tibial plateau fractures were treated by two-incision approaches. There were 16 males (including 1 case of bilateral), and 8 females, with mean age of 40.6 years (21-65 years), eleven fractures occurred in left extremity and 14 in the right. No patients suffered open fractures. Fracture was caused by fall from height in 10 cases, by traffic accident in 12 cases and by another causes in 2 cases. According to Schatzker classification, type V fracture was found in 14 extremities, type VI in 11 extremities. All cases were operated with two-incision approaches and double-plates fixation. The operation was performed 6-15 days after injury with mean 10.4 days.

All cases were followed up from 12 to 23 months (mean 15.6 months). Time of the bone healing was 6-9 months, with mean 7.4 months. No reduction of anatomy was achieved because of comminuted fractures of articular surfaces in 2 limbs. The line of the lower extremity did not recover because of metaphysis comminution in 1 limb, which led to knee varus. Epidermal necrolysis was observed in 3 limbs, and the wound healed after change dressing. The function of the knee was evaluated according to Rasmussen's criteria, the results were excellent in 10 limbs, good in 8 limbs, fair in 3 limbs, and poor in 4 limbs.

The two-incision approaches reduced the complication of soft-tissue injury, which is conductive to reduction of articular surface. Double-plates provide a sufficient internal fixation. It can permit early motion of knee joint. Therefore, two-incision approach are an effective surgical approach of treatment of complex tibial plateau fractures.