A New Posterolateral Approach Without Fibula Osteotomy for the Treatment of Tibial Plateau Fractures

Abstract

The selection of a surgical approach for the treatment of tibia plateau fractures is an important decision. Approximately 7% of all tibia plateau fractures affect the posterolateral corner. Displaced posterolateral tibia plateau fractures require anatomic articular reduction and buttress plate fixation on the posterior aspect. These aims are difficult to reach through a lateral or anterolateral approach. The standard posterolateral approach with fibula osteotomy and release of the posterolateral corner is a traumatic procedure, which includes the risk of fragment denudation. Isolated posterior approaches do not allow sufficient visual control of fracture reduction, especially if the fracture is complex. Therefore, the aim of this work was to present a surgical approach for posterolateral tibial plateau fractures that both protects the soft tissue and allows for good visual control of fracture reduction. The approach involves a lateral arthrotomy for visualizing the joint surface and a posterolateral approach for the fracture reduction and plate fixation, which are both achieved through one posterolateral skin incision. Using this approach, we achieved reduction of the articular surface and stable fixation in six of seven patients at the final follow-up visit. No complications and no loss of reduction were observed. Additionally, the new posterolateral approach permits direct visual exposure and facilitates the application of a buttress plate. Our approach does not require fibular osteotomy, and fragments of the posterolateral corner do not have to be detached from the soft tissue network.

The extended posterolateral approach for split depression lateral tibial plateau fractures extending into the posterior column: 2 years follow up results of a prospective study

“…Approaches specific to access fractures in the posterolateral corner were described by Solomon et al [5], Carlson [3] and a few other authors [12][13][14][15][16]. These approaches are useful to address fractures isolated to the posterolateral corner.…”

A posterior reversed L-shaped approach for the tibial plateau fractures—A prospective study of complications (95 cases)

“…Given the high incidence of 68.5% in tibial plateau fractures involving the posterior column and plenty of important anatomical structures locating in the posterolateral site of the knee, how to manage the posterolateral column remains a big challenge in clinical practice. The PRLA was designed, unlike early ones [18][19][20][21][22][23][24], not only for the management of posterior (both posteromedial and posterolateral) tibial plateau fractures but also, while combined with the anterolateral approach, all the three columns of tibial plateau could be exposed as a whole. For the posterolateral fragments management, the advantages and disadvantages of the PRLA had been discussed in early studies [5,7,25].…”

Tibial plateau fractures – review of current concepts in management

“…18,19 Some fracture patterns involve the posterolateral aspect of the fibula that cannot be reduced using an anterolateral approach. The soft tissue tension of the popliteal corner structures can prevent reduction.…”