Abstract：Objective To investigate the clinical efficacy of "reversed floating" position in the treatment of tibial plateau fractures involving the posterior column. Methods The clinical data of 19 patients (12 males and 5 females) who had tibial plateau fractures involving the posterior condylar and were admitted to the Department of Trauma Center of Anqing Hospital Affiliated to Anhui Medical University from September 2018 to August 2020 were analyzed retrospectively. Their average age was 38.5 years (range of 28-70 years). They were categorized according to Schatzker classification: 1 patient in type Ⅱ, 4 patients in type Ⅳ, 7 patients in type Ⅴ, and 7 patients in type Ⅵ. Their column fractures were classified as follows: 1 patient with posterior column fracture combined with lateral column fracture, 4 patients with posterior column fracture combined with medial column fracture, and 14 patients with posterior column fracture combined with lateral column fracture and medial column fracture. All patients were operated in a "reversed floating" position. An inverted "L" incision behind the medial knee joint was made for the 4 patients with posterior column fracture combined the medial column fracture of the tibial plateau. The remaining 15 patients was made an "L" incision and anterolateral incision of the knee joint. The fracture was well exposed during the operation. Operation time, intraoperative bleeding, and wound healing were observed and recorded. Regular follow-up and X-ray examination of the injured knee were performed to evaluate the clinical efficacy of internal fixation and fracture healing. Varus angle and posterior angle of tibial plateau were measured and compared immediately after surgery and 1 year after surgery. The knee function was assessed by the hospital for special surgery (HSS) knee score one year after surgery. Results All 19 patients underwent open reduction and internal fixation successfully in the "reversed floating" position. The operation time was 60-115 min, with an average of 91.6 min. Intraoperative blood loss was 50-200 mL, with an average of 108 mL. The patients recovered well after operation, and all the incisions healed. All 19 patients were followed up for 12-18 months, with an average of 13.5 months. None of the patients had internal fixation loosening or fracture during the follow-up period, and the fracture healing time was 17-25 weeks, with an average of 19.2 weeks. Immediately after surgery, the varus angle of tibial plateau was 87.16°±2.24° and the posterior angle of tibial plateau was 9.41°±0.85°. One year after surgery, the varus Angle of tibial plateau was 85.98°±3.59° and the posterior Angle of tibial plateau was 9.55°±0.97°. There was no significant difference in varus Angle and posterior Angle of tibial plateau immediately after operation and 1 year after operation (t=1.29, 2.01, all P values> 0.05). HSS knee score was used to evaluate knee function 1 year after operation: excellent in 9 cases, good in 8 cases and moderate in 2 cases. Conclusion The treatment of tibial plateau fractures involving the posterior column through the reversed floating position can result in good exposure, safe operation, stable and effective fixation, and satisfactory function.
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2022, Vol. 27 
