Tibial plateau fractures are common clinical injuries, with Schatzker type II fractures, characterized by lateral cortical split combined with lateral articular surface depression, being the most prevalent. To restore the depressed articular surface and reconstruct the normal joint alignment of the knee, surgical treatment is typically recommended.
The anterolateral approach to the knee joint involves directly lifting the lateral articular surface along the split cortex to reposition the depressed articular surface and perform bone grafting under direct vision, a method commonly used in clinical practice known as the "book opening" technique. Creating a window in the lateral cortex and using an elevator through the window to reposition the depressed articular surface, known as the "windowing" technique, is theoretically a more minimally invasive method.
There is no definitive conclusion on which of the two methods is superior. To compare the clinical efficacy of these two techniques, doctors from Ningbo Sixth Hospital conducted a comparative study.
The study included 158 patients, with 78 cases using the windowing technique and 80 cases using the book opening technique. The baseline data of the two groups showed no statistically significant differences:
▲ The figure illustrates the cases of the two articular surface reduction techniques: A-D: windowing technique, E-F: book opening technique.
Study results indicate:
- There was no statistically significant difference in the time from injury to surgery or the duration of the surgery between the two methods.
- Postoperative CT scans showed that the windowing group had 5 cases of postoperative articular surface compression, whereas the book opening group had 12 cases, a statistically significant difference. This suggests that the windowing technique provides better articular surface reduction than the book opening technique. Additionally, the incidence of severe traumatic arthritis post-surgery was higher in the book opening group compared to the windowing group.
- There was no statistically significant difference in postoperative knee function scores or VAS (Visual Analog Scale) scores between the two groups.
Theoretically, the book opening technique allows for a more thorough direct visualization of the articular surface, but it may lead to excessive opening of the articular surface, resulting in insufficient reference points for reduction and defects in subsequent articular surface reduction.
In clinical practice, which method would you choose?
Post time: Jul-30-2024
