A Modified Direct Posterior Midline Approach for the Treatment of Posterior Column Tibial Plateau Fractures

Abstract

The purpose of this study was to introduce a modified surgical approach for the treatment of posterior column tibial plateau fractures. Fifteen patients with posterior column fractures with or without other column fractures were included and treated with this approach between July 2015 and June 2016. The patients were followed up for 18 to 24 months (20.9 ± 1.8 months). Outcomes included neural or vascular injuries, wound complications, nonunion, plate loosening or breakage, and Hospital for Special Surgery (HSS) scores. Bone union was observed in all cases, and the average time for bone union was 13.5 ± 1.4 weeks (11–16 weeks). No neurovascular injuries, malunion, nonunions, or plate loosening or breakages were observed. The average HSS score was 94.7 ± 4.1 (range: 84–100). The modified direct posterior midline approach can provide excellent exposure and facilitate reduction and internal fixation of posterior column fractures of the tibial plateau, including split and depressed fractures. We expect that this approach can be used as a new effective method for managing complex posterior tibial fractures.

Comparative Analysis of Posterior Approach Versus Anterior Approach for Posterior Tibial Plateau Fractures

“…According to the ROBINS-1 assessment tool 41 , 5 studies 16,23,25,26,40 were with a moderate risk of bias, 11 studies 6,17,19,24,27,28,30,31,36,37,39 were rated with a serious risk of bias, and 13 studies 2,7,8,18,20-22,29,32-35,38 were rated with a critical risk of bias (Appendices 1 and 2; http://links.lww.com/JBJSREV/A970). Twelve studies did not report the underlying diseases of the patients, which raises some concerns about adjusting confounding factors 2,6-8,17-22,24,27-39 . This was rated as raising some concerns.…”

“…The included studies were conducted in the United States (2 studies, n = 44) 16,17 , China (17 studies, n = 413) 2,6,18-32 , India (3 studies, n = 85) 33-35 , Taiwan (5 studies, n = 162) 7,8,36-38 , South Korea (1 study, n = 18) 39 , and Turkey (1 study, n = 25) 40 . Fourteen studies used the anterior approach (10 open surgery, 4 arthroscopic surgery) 6-8,16,19,23,24,26,30,31,35,38-40 , 9 studies used the posterior approach 18,27-29,32-34,36,39 , and 11 studies used the anterior combined posterior approach 2,17,19-22,24,25,35,37,39 .…”

Modified Oblique Lobenhoffer (MOL) approach for posterolateral and posteromedial column access in tibial plateau fractures: a detailed cadaveric anatomical study

“…Several authors agree that the Luo approach can improve access to the PM and PL column [ 1 , 23 ]. Nevertheless, other authors referred limitations in the PL column exposure using the Luo approach [ 12 , 13 , 31 , 32 ]. Orapiriyakul et al.…”

Management of posterior column tibial plateau fracture via a posterior approach

“…In addition, a study by Yin et al, 13 investigated a modified direct posterior midline approach for the treatment of posterior column tibial plateau fractures, the study involved Fifteen patients were subjected to follow-ups for 18 to 24 months (20.9±1.8 months). Among these patients, eight patients required four quadrants fixation (PM, PL, AM, and AL), three patients required three quadrants fixation (PM, PL, and AM), three patients required two quadrants fixation (PM and PL), and one patient required one quadrant fixation (PL).…”

“…In addition regarding Tegner score at different follow up points, we found that the mean score immediate after operation was 6.5 ± 0.9, after 6 weeks was 5.6± 0.8, after 3 months was 4.4± 0.7 and after 5 months was 2.6± 0.9. While the study by Qiu et al, 9 13 utilized HSS score to assess the outcome and they found that the average HSS score was 94.7 ± 4.1 (range: 84-100).…”