Combined lateral femoral epicondylar osteotomy and a submeniscal approach for the treatment of a tibial plateau fracture involving the posterolateral quadrant

Yoon, Yong-Cheol; Sim, Jae‐Ang; Kim, Dong-Hyun; Lee, Beom-Koo

doi:10.1016/j.injury.2014.12.006

Cited by 49 publications

(32 citation statements)

References 12 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Gavaskar

Gopalan

Tummala³

2016

Injury

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Section: Discussionmentioning

confidence: 99%

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

Gavaskar

Gopalan

Tummala³

2016

Injury

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“…The lateral epicondyle is re-attached with a cortical screw. 39,40 Potential problems with this osteotomy consolidation could produce residual posterolateral instability. The two latter approaches facilitate articular fracture reduction because a bigger varus can be obtained, but present difficulties adequately fixing the posterolateral fragments.…”

Section: What Are the Indications For Surgical Treatment?mentioning

confidence: 99%

Treatment strategy for tibial plateau fractures: an update

2016

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Tibial plateau fractures are complex injuries produced by high- or low-energy trauma. They principally affect young adults or the ‘third age’ population.These fractures usually have associated soft-tissue lesions that will affect their treatment. Sequential (staged) treatment (external fixation followed by definitive osteosynthesis) is recommended in more complex fracture patterns. But one should remember that any type of tibial plateau fracture can present with soft-tissue complications.Typically the Schatzker or AO/OTA classification is used, but the concept of the proximal tibia as a three-column structure and the detailed study of the posteromedial and posterolateral fragment morphology has changed its treatment strategy.Limb alignment and articular surface restoration, allowing early knee motion, are the main goals of surgical treatment. Partially articular factures can be treated by minimally-invasive methods and arthroscopy is useful to assist and control the fracture reduction and to treat intra-articular soft-tissue injuries.Open reduction and internal fixation (ORIF) is the gold standard treatment for these fractures. Complex articular fractures can be treated by ring external fixators and minimally-invasive osteosynthesis (EFMO) or by ORIF. EFMO can be related to suboptimal articular reduction; however, outcome analysis shows results that are equal to, or even superior to, ORIF. The ORIF strategy should also include the optimal reduction of the articular surface.Anterolateral and anteromedial surgical approaches do not permit adequate reduction and fixation of posterolateral and posteromedial fragments. To achieve this, it is necessary to reduce and fix them through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement.Some authors have also suggested that primary total knee arthroplasty could be an option in specific patients and with specific fracture patterns.Cite this article: Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev 2016;1:225-232. DOI: 10.1302/2058-5241.1.000031.

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“…Thus, a fibular osteotomy, 13,14 lateral femoral epicondylar osteotomy 15 or posterolateral approach may be necessary.…”

Section: Treatment Options: Approaches and Techniquesmentioning

confidence: 99%

Section: Treatment Options: Approaches and Techniquesmentioning

confidence: 99%

“…Thus, the vision can be extended by performing an osteotomy of the fibula, 13,14 the lateral femoral epicondyle 15,17 or a combined submeniscal approach to better address the posterior fragments. The femoral epicondylar osteotomy 15 has a lower risk for neurovascular damage compared with the proximal fibular osteotomy. 13,14 In 90° flexion, the iliotibial tract is horizontally incised and the area around the lateral femoral epicondyle, including the insertions of the lateral collateral ligament and the popliteus tendon, is identified and prepared.…”

Section: Treatment Options: Approaches and Techniquesmentioning

confidence: 99%

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Partial proximal tibia fractures

2017

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Partial tibial plateau fractures may occur as a consequence of either valgus or varus trauma combined with a rotational and axial compression component.High-energy trauma may result in a more complex and multi-fragmented fracture pattern, which occurs predominantly in young people. Conversely, a low-energy mechanism may lead to a pure depression fracture in the older population with weaker bone density.Pre-operative classification of these fractures, by Müller AO, Schatzker or novel CT-based methods, helps to understand the fracture pattern and choose the surgical approach and treatment strategy in accordance with estimated bone mineral density and the individual history of each patient.Non-operative treatment may be considered for non-displaced intra-articular fractures of the lateral tibial condyle. Intra-articular joint displacement ⩾ 2 mm, open fractures or fractures of the medial condyle should be reduced and fixed operatively. Autologous, allogenic and synthetic bone substitutes can be used to fill bone defects.A variety of minimally invasive approaches, temporary osteotomies and novel techniques (e.g. arthroscopically assisted reduction or ‘jail-type’ screw osteosynthesis) offer a range of choices for the individual and are potentially less invasive treatments.Rehabilitation protocols should be carefully planned according to the degree of stability achieved by internal fixation, bone mineral density and other patient-specific factors (age, compliance, mobility). To avoid stiffness, early functional mobilisation plays a major role in rehabilitation. In the elderly, low-energy trauma and impression fractures are indicators for the further screening and treatment of osteoporosis.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160067. Originally published online at www.efortopenreviews.org

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Combined lateral femoral epicondylar osteotomy and a submeniscal approach for the treatment of a tibial plateau fracture involving the posterolateral quadrant

Cited by 49 publications

References 12 publications

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

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

Treatment strategy for tibial plateau fractures: an update

Partial proximal tibia fractures

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