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.
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References
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
Carlson DA (2005) Posterior bicondylar tibial plateau fractures. J Orthop Trauma 19:73–78
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
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
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
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
Johnson EE, Timon S, Osuji C (2013) Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures. Clin Orthop Relat Res 471:2760–2767
Kenneth AE (2005) Split depression posterolateral tibial plateau fracture: direct open reduction and internal fixation. Tech Knee Surg 4:257–262
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
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
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
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
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
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
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
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
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
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
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
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).
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Hong-Wei Chen and Sheng-Hu Zhou contributed equally to this work.
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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
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DOI: https://doi.org/10.1007/s00167-014-3304-y