Expanding indications of the horizontal belt plate: A technical note

Pires, Robinson Esteves Santos; Giordano, Vincenzo; Santos, Jean Klay dos; Labronici, Pedro José; Andrade, Marco Antônio Percope de; Lourenço, Paulo Roberto Barbosa de Toledo

doi:10.1016/j.injury.2015.06.024

Cited by 10 publications

(5 citation statements)

References 7 publications

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“…17 A smallfragment nonlocked or locked plate is precontoured and inserted from lateral to medial, so it sits exactly on the PL proximal aspect of the tibial plateau, parallel and closer to the articular joint line, wrapping the avulsed fracture fragments. 1,33 The plate should be completely adjusted to the bone anatomy of the PL corner of the knee. There is no room to place screws from the posterior to the anterior lateral tibial plateau, so the screws should be inserted from the lateral to the medial tibial plateau (►Fig.…”

Section: Surgical Techniques For Reconstruction Based On the Type Of mentioning

confidence: 99%

“…An alternative to this, mainly when there is a poor bone stock, is to use a horizontal nonlocked or locked plate as a big washer. 1, 17,27,32,33 Additional two to three anterolateral-to-PL 2.7-mm or 3.5-mm cortical screws with washers are introduced in a "jail technique" to prevent screw cut-out. 41 Careful measurement of the screws is important, as long screws posteriorly can damage overlying soft tissues.…”

Section: Surgical Techniques For Reconstruction Based On the Type Of mentioning

confidence: 99%

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Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

et al. 2020

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High-energy fractures of the proximal tibia with extensive fragmentation of the posterolateral (PL) quadrant of the tibial plateau are challenging to manage. Herein, we present a review of the literature on the patterns and options of approach and fixation of the PL fragment of the tibial plateau to optimize the treatment of this specific injury pattern. We searched PubMed (1980–May 2020) to identify and summarize the most relevant articles evaluating both the morphology and treatment recommendations, including the choice of approach and fixation strategy, for the PL tibial plateau fracture. We found PL fragment can present in several patterns as a pure split, split depression, contained pure depression, and noncontained depression (rim crush), which are mostly determined by the position of the knee and the force magnitude applied during the course of the accident. Based on previous concepts described by Schatzker and Kfuri, we suggest a simplified treatment algorithm highlighting the two concepts (buttressing and containment) used for plating the PL tibial plateau fragments. Based on the available current evidence, we propose an algorithm for these two morphological types of PL tibial plateau fracture. Shear-type fractures need buttressing (the “rule of thumb”), whereas noncontained peripheral rim-type fractures need peripheral repair and containment. Contained pure depression fractures are not frequent and need percutaneous-assisted elevation and subchondral rafting, either controlled by fluoroscopy or arthroscopically. It is believed that such an approach would simplify their assessment and preoperative planning and would assist the clinicians to appreciate and manage more consistently these complex injuries.

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Section: Surgical Techniques For Reconstruction Based On the Type Of mentioning

confidence: 99%

Section: Surgical Techniques For Reconstruction Based On the Type Of mentioning

confidence: 99%

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

et al. 2020

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“…11 ). This technique expands the applications of the horizontal plating concept [ 18 , 19 , 23 , 24 , 49 , 50 ], offering a novel alternative that allows direct control and proximal screw fixation of the PL column through the MOL approach.…”

Section: Discussionmentioning

confidence: 99%

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

Boluda-Mengod,

Olías-López,

Forcada-Calvet

et al. 2024

J Orthop Traumatol

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Background Tibial plateau fractures involving posteromedial (PM) and posterolateral (PL) columns are complex injuries that require an appropriate approach. The management of the PL column in these cases can be controversial, and limitations using deep posteromedial interval approaches have been referenced. In this paper, a modification of the Lobenhoffer approach, designed to optimize the access to the PL column, is described in detail. The aim of this study was to assess the feasibility of this approach in a cadaveric anatomical study. Materials and methods In total, five fresh-frozen cadaveric specimens were used for detailed anatomical study surrounding the approach. Relationships with cutaneous and deep neurovascular structures were evaluated. The exposure area of the PL and PM columns using this approach was assessed. Results The cadaveric study showed safe and adequate exposure. Oblique skin and fascia incision just medial to the posterior midline was safe to protect the medial sural cutaneous nerve and the small saphenous vein. Elevation of the popliteus and tibialis posterior muscles offered safe protection of the anterior tibial artery and popliteal neurovascular bundle during retractor placement. Adequate full proximal exposure of the PM and PL columns, including the posterolateral lateral (PLL) and posterolateral central (PLC) segments, was obtained in all specimens. Conclusions The Modified Oblique Lobenhoffer (MOL) approach can be a feasible option to access PL and PM columns in tibial plateau fractures. Level of evidence IV.

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“…At the distal end of the plate, a regular anatomical locking plate was also used for fixing the proximal tibia. In 2017, Pires et al 10 reported using a horizontal rafting plate for treating a tibial plateau fracture, with the posterolateral side involved. The surgeries were conducted via the fibular neck osteotomy approach to expose the posterolateral plateau.…”

Section: Fixation Of the Fracture Of The Posterolateral Tibial Plateaumentioning

confidence: 99%

“…In their study, the conventional reconstruction plate was shaped along the shape of the tibial plateau at the level of the articular rim of the tibial plateau, which was fixed using several screws at different levels. At present, this method is used for the accessory treatment of periarticular fractures, such as fractures of the distal femur, ankle, and proximal humerus 10 . However, for the fracture of the posterolateral tibial plateau, fixation is influenced by the fibula, making fixation very difficult.…”

Section: Introductionmentioning

confidence: 99%

Horizontal Rafting Plate for Treatment of the Tibial Plateau Fracture

Liu

Zhang

et al. 2021

Orthopaedic Surgery

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This study aimed to investigate the value of a horizontal rafting plate in treating tibial plateau fractures.Methods: The data of 24 patients in whom a horizontal rafting plate was used to treat a tibial plateau fracture between October 2014 and January 2018 were retrospectively analyzed, including 16 males and 8 females, aged 21-63 years old, with an average of 40 AE 14.68 years. The fractures included 13 in the left knee and 11 in the right knee. The places where the horizontal rafting plate were used included the anterior margin of tibia, anterolateral tibia, and posterolateral tibia. All cases were followed up for 12-24 months, with an average follow-up of 17.5 AE 5.0 months. At the last follow-up, the Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation. The knee joint function was evaluated using the Rasmussen functional score. Computed tomography (CT) scanning and three-dimensional reconstruction were performed preoperatively and postoperatively, with the quality of reduction of the fractured articular surface clarified by the final follow-up. The flexion and extension abilities of the knee joint were also measured in the postoperative follow-up.Results: Preoperative CT scanning showed that the gap of the tibial plateau was 8.00 AE 1.40 (5-24) mm. The heights of the fracture of the articular surface at all three sites during the final follow-ups were significantly different from the height before the surgery (P < 0.05). The vertical distance between the articular line and the highest point of the articular surface after reduction was 0.17 AE 0.05 mm. Anatomic reductions were obtained in 24 patients. The Rasmussen functional score after surgeries was 27.25 AE 0.94 points. Bony union was achieved in all the patients. According to the Rasmussen radiological criteria, the scores during the last follow-up were as follows: the total score was 13-18 points, with an average of 16.00 AE 1.72 points; the scores were excellent in 17 cases and good in seven cases. Therefore, 100% of results were excellent or good. No infection or fracture nonunion was found. Conclusion:Using a horizontal plate can be an effective method for treating special types of fractures of the tibial plateau, including the anterior margin and anterolateral and posterolateral tibial plateau, with satisfactory treatment efficacy.

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Expanding indications of the horizontal belt plate: A technical note

Cited by 10 publications

References 7 publications

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

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

Horizontal Rafting Plate for Treatment of the Tibial Plateau Fracture

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