Comparative study on effectiveness of double reverse traction reduction versus open reduction internal fixation in treating complex tibial plateau fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Hao , LIN Zhihao , MA Yueyan , GONG Haifeng , WANG Tianrui , YE Fagang ,  HU Yanling

Department of Trauma Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266035?, P. R. China;

Corresponding?author：

HU Yanling, Email: huyanlingqy@126.com

Keywords：

Tibial plateau fracture; complex fracture; traction reduction; closed reduction; internal fixation; minimally invasive surgery

DOI：

10.7507/1002-1892.202504101

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the effectiveness and advantages of the double reverse traction reduction versus open reduction internal fixation for treating complex tibial plateau fractures. Methods A clinical data of 25 patients with Schatzker type Ⅴ or Ⅵ tibial plateau fractures, who met the selection criteria and were admitted between January 2019 and January 2023, was retrospectively analyzed. Thirteen patients underwent double reverse traction reduction and internal fixation (double reverse traction group), while 12 patients underwent open reduction and internal fixation (traditional open group). There was no significant difference in the baseline data (age, gender, injury mechanism, Schatzker classification, interval between injury and operation) between the two groups (P>0.05). The effectiveness were evaluated and compared between the two groups, included operation time, intraoperative blood loss, incision length, hospital stay, full weight-bearing time, complications, fracture healing, Rasmussen radiological score (reduction quality), knee Hospital for Special Surgery (HSS) score, and knee flexion/extension range of motion. Results The double reverse traction group demonstrated significantly superior outcomes in operation time, intraoperative blood loss, hospital stay, incision length, and time to full weight-bearing (P<0.05). Two patients in traditional open group developed incisional complications, while the double reverse traction group had no complication. There was no significant difference in the incidence of complication between the two groups (P>0.05). All patients were followed up 24-36 months (mean, 30 months), with no significant difference in follow-up duration between groups (P>0.05). Fractures healed in both groups with no significant difference in healing time (P>0.05). At 6 months after operation, Rasmussen radiological scores and grading showed no significant difference between the two groups (P>0.05); the double reverse traction group had significantly higher HSS scores compared to the traditional open group (P<0.05). At 12 months after operation, knee flexion/extension range of motion were significantly greater in the double reverse traction group than in the traditional open group (P<0.05). Conclusion Double reverse traction reduction offers advantages over traditional open reduction, including shorter operation time, reduced blood loss, minimized soft tissue trauma, and improved joint functional recovery. It is a safe and reliable method for complex tibial plateau fractures.

Citation： LIU Hao, LIN Zhihao, MA Yueyan, GONG Haifeng, WANG Tianrui, YE Fagang, HU Yanling. Comparative study on effectiveness of double reverse traction reduction versus open reduction internal fixation in treating complex tibial plateau fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(7): 795-800. doi: 10.7507/1002-1892.202504101 Copy

1.	Liu CD, Hu SJ, Chang SM, et al. Treatment of posterolateral tibial plateau fractures: a narrative review and therapeutic strategy. Int J Surg, 2025, 111(1): 1071-1082.
2.	Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968—1975. Clin Orthop Relat Res, 1979, (138): 94-104.
3.	Rohra N, Suri HS, Gangrade K. Functional and radiological outcome of Schatzker type Ⅴ and Ⅵ tibial plateau fracture treatment with dual plates with minimum 3 years follow-up: A prospective study. J Clin Diagn Res, 2016, 10(5): RC05-10. doi: 10.7860/JCDR/2016/18732.7855.
4.	Chapman JP, Patrick MR, Reb CW, et al. Comparable outcomes with intramedullary nail and plate constructs for Schatzker Ⅵ tibial plateau fractures. Eur J Orthop Surg Traumatol, 2023, 33(5): 1653-1661.
5.	Gavaskar AS, Gopalan H, Tummala NC, et al. The extended posterolateral approach for split depression lateral tibial plateau fractures extending into the posterior column: 2 years follow up results of a prospective study. Injury, 2016, 47(7): 1497-1500.
6.	Bertrand ML, Pascual-López FJ, Guerado E. Severe tibial plateau fractures (Schatzker Ⅴ-Ⅵ): open reduction and internal fixation versus hybrid external fixation. Injury, 2017, 48 Suppl 6: S81-S85.
7.	蘇喧. 張英澤: 雙反牽引微創復位固定治療脛骨平臺骨折. 中國醫藥科學, 2016, 6(5): 1-3.
8.	Wang Z, Zheng Z, Ye P, et al. Treatment of tibial plateau fractures: A comparison of two different operation strategies with medium-term follow up. J Orthop Translat, 2022, 36: 1-7.
9.	Deng X, Hu H, Wang Y, et al. Arthroscopically assisted evaluation of frequency and patterns of meniscal tears in operative tibial plateau fractures: a retrospective study. J Orthop Surg Res, 2021, 16(1): 117. doi: 10.1186/s13018-021-02265-0.
10.	Cao F, Xue H, Yan C, et al. Clinical application study of minimally invasive double-reverse traction in complex tibial plateau fractures. Biomed Res Int, 2022, 2022: 5564604. doi: 10.1155/2022/5564604.
11.	Smith TO, Casey L, McNamara IR, et al. Surgical fixation methods for tibial plateau fractures. Cochrane Database Syst Rev, 2024, 8(8): CD009679. doi: 10.1002/14651858.CD009679.pub3.
12.	Coelho A, Parés-Alfonso I, Companys R, et al. Risk factors for infection of tibial plateau fractures. Rev Esp Cir Ortop Traumatol, 2024, 68(1): 44-49.
13.	Kim CW, Lee CR, An KC, et al. Predictors of reduction loss in tibial plateau fracture surgery: Focusing on posterior coronal fractures. Injury, 2016, 47(7): 1483-1487.
14.	姜新峰, 陳華. 股骨撐開器輔助復位治療不穩定型脛骨平臺骨折療效分析. 江蘇醫藥, 2016, 42(13): 1511-1512.
15.	張英澤. 順勢復位固定微創治療脛骨平臺骨折. 中華骨科雜志, 2023, 43(22): 1473-1476.
16.	扈延齡, 徐鳳磊, 李春燕, 等. 雙反牽引復位微創經皮接骨板內固定術治療脛骨中遠段粉碎性骨折. 中國矯形外科雜志, 2018, 26(12): 1140-1142.
17.	王博, 鄭占樂, 劉歡, 等. 張氏加壓骨栓治療脛骨平臺骨折的初步臨床應用. 河北醫科大學學報, 2018, 39(7): 851-852.
18.	鄭占樂, 連曉東, 王博, 等. 經脛前隧道推頂復位脛骨平臺塌陷骨折. 中華創傷骨科雜志, 2020, 22(8): 693-697.
19.	陳陽, 劉忠玉, 趙俊超, 等. 關節鏡輔助復位內固定治療Schatzker Ⅰ~Ⅲ型脛骨平臺骨折. 中華骨科雜志, 2022, 42(10): 644-651.
20.	Kiefer H, Zivaljevic N, Imbriglia JE. Arthroscopic reduction and internal fixation (ARIF) of lateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc, 2001, 9(3): 167-172.
21.	鄧翔天, 鄭占樂, 邵德成, 等. 關節鏡下評估脛骨平臺骨折合并半月板撕裂和交叉韌帶損傷的臨床研究. 中華外科雜志, 2021, 59(6): 464-469.
22.	王東, 鄧翔天, 趙仁良, 等. 雙反牽引輔助復位與切開復位內固定治療脛骨平臺骨折的療效比較. 中華骨科雜志, 2023, 43(22): 1477-1484.

1. Liu CD, Hu SJ, Chang SM, et al. Treatment of posterolateral tibial plateau fractures: a narrative review and therapeutic strategy. Int J Surg, 2025, 111(1): 1071-1082.
2. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968—1975. Clin Orthop Relat Res, 1979, (138): 94-104.
3. Rohra N, Suri HS, Gangrade K. Functional and radiological outcome of Schatzker type Ⅴ and Ⅵ tibial plateau fracture treatment with dual plates with minimum 3 years follow-up: A prospective study. J Clin Diagn Res, 2016, 10(5): RC05-10. doi: 10.7860/JCDR/2016/18732.7855.
4. Chapman JP, Patrick MR, Reb CW, et al. Comparable outcomes with intramedullary nail and plate constructs for Schatzker Ⅵ tibial plateau fractures. Eur J Orthop Surg Traumatol, 2023, 33(5): 1653-1661.
5. Gavaskar AS, Gopalan H, Tummala NC, et al. The extended posterolateral approach for split depression lateral tibial plateau fractures extending into the posterior column: 2 years follow up results of a prospective study. Injury, 2016, 47(7): 1497-1500.
6. Bertrand ML, Pascual-López FJ, Guerado E. Severe tibial plateau fractures (Schatzker Ⅴ-Ⅵ): open reduction and internal fixation versus hybrid external fixation. Injury, 2017, 48 Suppl 6: S81-S85.
7. 蘇喧. 張英澤: 雙反牽引微創復位固定治療脛骨平臺骨折. 中國醫藥科學, 2016, 6(5): 1-3.
8. Wang Z, Zheng Z, Ye P, et al. Treatment of tibial plateau fractures: A comparison of two different operation strategies with medium-term follow up. J Orthop Translat, 2022, 36: 1-7.
9. Deng X, Hu H, Wang Y, et al. Arthroscopically assisted evaluation of frequency and patterns of meniscal tears in operative tibial plateau fractures: a retrospective study. J Orthop Surg Res, 2021, 16(1): 117. doi: 10.1186/s13018-021-02265-0.
10. Cao F, Xue H, Yan C, et al. Clinical application study of minimally invasive double-reverse traction in complex tibial plateau fractures. Biomed Res Int, 2022, 2022: 5564604. doi: 10.1155/2022/5564604.
11. Smith TO, Casey L, McNamara IR, et al. Surgical fixation methods for tibial plateau fractures. Cochrane Database Syst Rev, 2024, 8(8): CD009679. doi: 10.1002/14651858.CD009679.pub3.
12. Coelho A, Parés-Alfonso I, Companys R, et al. Risk factors for infection of tibial plateau fractures. Rev Esp Cir Ortop Traumatol, 2024, 68(1): 44-49.
13. Kim CW, Lee CR, An KC, et al. Predictors of reduction loss in tibial plateau fracture surgery: Focusing on posterior coronal fractures. Injury, 2016, 47(7): 1483-1487.
14. 姜新峰, 陳華. 股骨撐開器輔助復位治療不穩定型脛骨平臺骨折療效分析. 江蘇醫藥, 2016, 42(13): 1511-1512.
15. 張英澤. 順勢復位固定微創治療脛骨平臺骨折. 中華骨科雜志, 2023, 43(22): 1473-1476.
16. 扈延齡, 徐鳳磊, 李春燕, 等. 雙反牽引復位微創經皮接骨板內固定術治療脛骨中遠段粉碎性骨折. 中國矯形外科雜志, 2018, 26(12): 1140-1142.
17. 王博, 鄭占樂, 劉歡, 等. 張氏加壓骨栓治療脛骨平臺骨折的初步臨床應用. 河北醫科大學學報, 2018, 39(7): 851-852.
18. 鄭占樂, 連曉東, 王博, 等. 經脛前隧道推頂復位脛骨平臺塌陷骨折. 中華創傷骨科雜志, 2020, 22(8): 693-697.
19. 陳陽, 劉忠玉, 趙俊超, 等. 關節鏡輔助復位內固定治療Schatzker Ⅰ~Ⅲ型脛骨平臺骨折. 中華骨科雜志, 2022, 42(10): 644-651.
20. Kiefer H, Zivaljevic N, Imbriglia JE. Arthroscopic reduction and internal fixation (ARIF) of lateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc, 2001, 9(3): 167-172.
21. 鄧翔天, 鄭占樂, 邵德成, 等. 關節鏡下評估脛骨平臺骨折合并半月板撕裂和交叉韌帶損傷的臨床研究. 中華外科雜志, 2021, 59(6): 464-469.
22. 王東, 鄧翔天, 趙仁良, 等. 雙反牽引輔助復位與切開復位內固定治療脛骨平臺骨折的療效比較. 中華骨科雜志, 2023, 43(22): 1477-1484.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study on effectiveness of double reverse traction reduction versus open reduction internal fixation in treating complex tibial plateau fractures

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content