Efficacies of different surgical approaches in the treatment of hyperextension tibial plateau fractures.

Objective: To investigate the clinical efficacies of an anteromedial combined with anterolateral approach versus posteromedial combined with anterolateral approach in the treatment of hyperextension tibial plateau fractures.

Methods: A retrospective analysis was conducted on the data of 112 patients with hyperextension tibial plateau fractures treated in the Orthopedics Department of No. 215 Hospital of Shaanxi Nuclear Industry from January 2020 to December 2022. The patients were categorized as the control group (anteromedial combined with anterolateral approach, n=62) and the observation group (posteromedial combined with anterolateral approach, n=60) in accordance with the surgical approaches they underwent. Clinical outcomes, surgical time, time needed to be able to undertake weight-bearing activities, Visual Analogue Scale (VAS) pain scores, and the incidence of postoperative complications were compared between the two groups. Knee joint function was assessed using the Hospital for Special Surgery (HSS) knee scoring system. Changes in the posterior tibial slope and varus angles were evaluated using X-ray imaging.

Results: All patients recovered from tibial plateau fractures after treatment, with their knee joint function returning to pre-injury status to a large degree. At 6 months postoperatively, there was no statistically significant difference in HSS knee scores between the two groups (P=0.775). However, at 12 months postoperatively, the HSS knee scores in the control group were significantly lower than those in the observation group (P < 0.001). Additionally, the rate of patients demonstrating excellent or good knee function was significantly lower in the control group than that in the observation group (P=0.041). In terms of pain evaluation, the VAS pain scores of patients were higher in the control group than those in the observation group on days 1 and 3 after surgery (P < 0.001), whereas no statistically significant difference was observed between the two groups on postoperative day 12 (P=0.337). At 6 months postoperatively, the posterior tibial slope angle was larger in the control group than that in the observation group (P < 0.01). The time needed to be able to undertake weight-bearing activities was markedly longer and the varus angle greater in the observation group than those in the control group on the day of surgery (P < 0.01). Lastly, there was no statistically significant difference in the incidence of complications between the two groups (P=0.045).

Conclusion: The posteromedial combined with anterolateral approach for treating hyperextension tibial plateau fractures has presented ideal clinical outcomes, reduced patients' pain, and promoted the recovery of their joint function without increasing the incidence of adverse reactions.