Objective To compare the clinical efficacy of using an improved medial combined with supracapular approach and conventional anterior and posterior medial approaches to place lateral "L" - shaped, medial "T" - shaped plates, and posterior blocking plates for the treatment of complex tibial plateau fractures of type Ⅴ and above.

Methods A retrospective study was conducted on 58 patients with complex tibial plateau fractures accompanied by posterior medial and posterior lateral platform collapse.In the improved group, the patient was placed in a supine "four figure" position during surgery, and an improved medial combined with supracapular was used.In the control group, a floating position was adopted and surgery was performed using anterior lateral and posterior internal approaches, respectively.If there were many bone defects during the operation, autologous bone grafting was performed.The surgical time, number of fluoroscopies, bleeding volume, complications, Rasmussen imaging score, HSS score, knee joint range of motion, tibial plateau angle, and medial posterior inclination angle were recorded.

Results All patients were followed up for 12 months.The incision length, fracture exposure time, surgical time, and intraoperative bleeding in the improved group were lower than those in the conventional group (P < 0.01).The HSS and Rasmussen scores of the improved group were higher than those of the conventional group at 1, 3 months after surgery (P < 0.01).The visual simulation scores of the improved group were lower than those of the conventional group at 1, 3, and 12 months after surgery (P < 0.01).The European five dimensional health scale index of the improved group was higher than that of the conventional group at 1, 3, and 12 months after surgery (P < 0.05 to P < 0.01).There was no statistically significant difference in other indicators between the two groups (P>0.05).

Conclusions Compared to conventional approaches, patients undergoing Schatzker type Ⅴ and Ⅵ tibial plateau fractures can effectively improve the fixation effect of the fracture site during surgery by using the improved medial combined with supracapular approach, which is beneficial for postoperative knee function repair.