Skip to main content

An extended anterolateral approach for posterolateral tibial plateau fractures

Knee Surgery, Sports Traumatology, Arthroscopy volume 23, pages 3750–3755 (2015)Cite this article

Abstract

Purpose

The best approach for treating posterolateral tibial plateau fractures remains controversial. The clinical results of an extended anterolateral approach on such fractures are discussed in this study.

Methods

Between 2010 and 2011, ten patients with posterolateral tibial plateau fracture were treated using an extended anterolateral approach with a proximal tibial locking compression plate. The epidemiological data, operation details, and clinical outcomes over 26.4 ± 2.3 months (range 24–30 months) of follow-up were prospectively collected and analyzed.

Results

The average surgical duration was 91.5 ± 18.7 min (range 80–130 min). An anatomic reduction rate of 90 % (9/10) was observed although one patient with a lateral comminuted fracture and dislocation presented a 2-mm joint surface depression postoperatively. The average fracture healing time was 10.6 ± 1.8 weeks (range 8–14 weeks), with an average hospital for special surgery knee score of 95.3 ± 6.5 points (range 80–100 points), an average knee flexion of 119.8° ± 17.2° (range 95°–140°) and an average knee extension of 2.1° ± 2.1° (range 0°–6°). No complications were found.

Conclusions

The extended anterolateral approach with a proximal tibial compression plate offers direct and complete surgical exposure and may provide an effective method for the surgical treatment of posterolateral tibial plateau fractures.

Level of evidence

Therapeutic, Level IV.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Bermudez CA, Ziran BH, Barrette-Grischow MK (2008) Use of horizontal rafting plates for posterior elements of complex tibial plateau fractures: description and case reports. J Trauma 65:1162–1167

    Article  PubMed  Google Scholar 

  2. Carlson DA (2005) Posterior bicondylar tibial plateau fractures. J Orthop Trauma 19:73–78

    Article  PubMed  Google Scholar 

  3. Chen HW, Liu GD, Ou S, Zhao GS, Pan J, Wu LJ (2013) Open reduction and internal fixation of postero-lateral tibial plateau fractures through fibula osteotomy-free postero-lateral approach. J Orthop Trauma. doi: 10.1097/BOT.0000000000000047

  4. Ghazavi MT, Pritzker KP, Davis AM, Gross AE (1997) Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br 79:1008–1013

    CAS  Article  PubMed  Google Scholar 

  5. Heidari N, Lidder S, Grechenig W, Tesch NP, Weinberg AM (2013) The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau: a cadaver study. J Orthop Trauma 27:221–225

    Article  PubMed  Google Scholar 

  6. Huang YG, Chang SM (2012) The posterolateral approach for plating tibial plateau fractures: problems in secondary hardware removal. Arch Orthop Trauma Surg 132:733–734

    Article  PubMed  Google Scholar 

  7. Johnson EE, Timon S, Osuji C (2013) Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures. Clin Orthop Relat Res 471:2760–2767

    PubMed Central  Article  PubMed  Google Scholar 

  8. Kenneth AE (2005) Split depression posterolateral tibial plateau fracture: direct open reduction and internal fixation. Tech Knee Surg 4:257–262

    Article  Google Scholar 

  9. Kumar A, Whittle AP (2000) Treatment of complex (Schatzker Type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review. J Orthop Trauma 14:339–344

    CAS  Article  PubMed  Google Scholar 

  10. Partenheimer A, Gosling T, Muller M, Schirmer C, Kaab M, Matschke S, Ryf C, Renner N, Wiebking U, Krettek C (2007) Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation. Unfallchirurg 110:675–683

    CAS  Article  PubMed  Google Scholar 

  11. Sabharwal S, Zhao C (2008) Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg Am 90:43–51

    Article  PubMed  Google Scholar 

  12. Sciadini MF, Sims SH (2013) Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type IV tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma 27:e18–e23

    Article  PubMed  Google Scholar 

  13. Seruya M, Oh AK, Rogers GF, Han KD, Boyajian MJ, Myseros JS, Yaun AL, Keating RF (2012) Blood loss estimation during fronto-orbital advancement: implications for blood transfusion practice and hospital length of stay. J Craniofac Surg 23:1314–1317

    Article  PubMed  Google Scholar 

  14. Solomon LB, Stevenson AW, Lee YC, Baird RP, Howie DW (2013) Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationale. J Orthop Trauma 24:505–514

    Article  Google Scholar 

  15. Tao J, Hang DH, Wang QG, Gao W, Zhu LB, Wu XF, Gao KD (2008) The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee 15:473–479

    Article  PubMed  Google Scholar 

  16. Yu B, Han K, Zhan C, Zhang C, Ma H, Su J (2010) Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee 17:313–318

    Article  PubMed  Google Scholar 

  17. Yu GR, Xia J, Zhou JQ, Yang YF (2012) Low-energy fracture of posterolateral tibial plateau: treatment by a posterolateral prone approach. J Trauma Acute Care Surg 72:1416–1423

    Article  PubMed  Google Scholar 

  18. Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zeng BF (2012) Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee 19:94–98

    Article  PubMed  Google Scholar 

  19. Zhao X, Yan SG, Li H, Wu HB (2012) Short reconstruction nail for intertrochanteric fracture: does it really fit Asian feature? Arch Orthop Trauma Surg 132:81–86

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by Key Science and Technology Program of Yiwu City (No.2009-G3-02), Military Twelfth Five Key Projects (No.BWS11J038), and Foundation of State Key Laboratory of Trauma, Burns and Combined Injuries (No.SKLKF201113).

Conflict of interest

None.

Author information

Affiliations

  1. Department of Orthopedic Surgery, Yiwu Central Hospital, Affiliated Hospital of Wenzhou Medical University, Yiwu, 322000, China

    Hong-Wei Chen

  2. Department of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730000, China

    Sheng-Hu Zhou

  3. 8th Department, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China

    Guo-dong Liu

  4. Department of Orthopedics, Second Hospital of Medical College of Zhejiang University, Hangzhou, 310009, China

    Xiang Zhao

  5. Department of Orthopedics, Second Hospital of Wenzhou Medical University, Wenzhou, 325027, China

    Jun Pan

  6. Department of Anesthesiology, General Hospital of Chengdu Military Command, Chengdu, 600041, China

    Shan Ou

  7. Traumatic Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China

    Jun Fei

Authors
  1. Hong-Wei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sheng-Hu Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guo-dong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shan Ou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jun Fei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guo-dong Liu.

Additional information

Hong-Wei Chen and Sheng-Hu Zhou contributed equally to this work.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chen, HW., Zhou, SH., Liu, Gd. et al. An extended anterolateral approach for posterolateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc 23, 3750–3755 (2015). https://doi.org/10.1007/s00167-014-3304-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3304-y

Keywords

  • Tibial plateau fracture
  • Approach
  • Tibial proximal locking plate
  • Internal fixation