Posterolateral fragment characteristics in tibial plateau fractures

Li, Qing; Zhang, Yingqi; Chang, Shi‐Min

doi:10.1007/s00264-013-2248-z

Cited by 17 publications

(23 citation statements)

References 5 publications

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“…We note that the morphological characteristics of the complex bicondylar four-quadrant tibial plateau fractures follow a regular pattern, which was also described by others [8][9][10][11][12]. The concave medial plateau is usually split into two large fragments (posteromedial and anteromedial) without articular depression, while the convex lateral plateau is split-depressed into various degrees of multi-fragments with broadening of the lateral compartment (anterolateral and posterolateral).…”

Section: Discussionmentioning

confidence: 61%

“…Chang et al [6,7] classified the tibial articular plateau into four-quadrants, and the fractures are categorized with an isolated single quadrant (anteromedial, anterolateral, posteromedial, and posterolateral) and different combinations of 2, 3 and 4 quadrants. The fracture on each quadrant may have unique characteristics [8][9][10][11][12] as well as require related incision or treatment protocols [13,14].…”

Section: Introductionmentioning

confidence: 99%

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A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Chang

Zhang

et al. 2014

International Orthopaedics (SICOT)

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Purpose Bicondylar tibial plateau fractures involving four articular quadrants are severe and complex injuries, and they remain a challenging problem in orthopaedic trauma. The aim of this study was to introduce a new treatment protocol with dual-incision and multi-plate fixation in the floating supine patient position as well as to report the preliminary clinical results. Methods From January 2006 to December 2011, 16 consecutive patients with closed bicondylar four-quadrant tibial plateau fractures (Schatzker type VI, OTA/AO 41C2/3) were treated with posteromedial inverted L-shaped and anterolateral incisions. With the posteromedial approach, three quadrants (posteromedial, anteromedial and posterolateral) can be exposed, reduced and fixed with multiple small antiglide plates and short screws in an enclosure pattern. With the anterolateral approach, after articular elevation and bone substitute grafting, a strong locking plate with long screws to the medial cortex is used to raft-buttress the reduced lateral plateau fracture, hold the entire reconstructed tibial condyles together, and contact the condyles with the tibial shaft. All patients were encouraged to exercise knee motion at an early stage. The outcome was evaluated clinically and radiologically after a minimum two-year follow-up. Results The average operation time was 98±26 minutes (range 70-128) and the average duration of hospitalization was 29±8.6 days (range 20-41). Three cases used five plates, nine cases used four plates, and four cases used three plates. All patients were followed for a mean of 28.7±6.1 months (range 26-38). Fifteen incisions healed initially, while one patient developed a medial wound dehiscence and was successfully managed by debridement. All patients achieved radiological fracture union after an average of 20.2 weeks. At the two-year follow up, the average knee range of motion (ROM) was 98°±13.7 (range 88-125°), with a Hospital for Special Surgery (HSS) knee score of 87.7±10.3 (range 75-95), and SMFA score of 21.3±8.6 (range 12-33). Conclusion For bicondylar four-quadrant tibial plateau fractures, the treatment protocol of multiple medial-posterior small plates combined with a lateral strong locking plate through dual incisions can provide stable fracture fixation to allow for early stage rehabilitation. Good clinical outcomes can be anticipated.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Chang

Zhang

et al. 2014

International Orthopaedics (SICOT)

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“…The morphological characteristics of the complex bicondylar four-quadrant tibial plateau fractures follow a regular pattern, which was also described by many authours. [2,3,34,35,36] The concave medial plateau is usually split into two large fragments (posteromedial and anteromedial) without articular depression, while the convex lateral plateau is split-depressed into various degrees of multi-fragments with broadening of the lateral compartment (anterolateral and posterolateral). The coronal posteromedial quadrant fragment usually has an inferior V-shaped cortical spike, which can intra operatively be used as a landmark.…”

Section: Clinical Results Number Of Cases Percentagementioning

confidence: 99%

Optimal Surgical Management of High Velocity Posterior Tibial Plateau Fracture Subluxations (Duparc, Revised Classification, Group – V: Postero-Medial Fracture) by Direct, Dorsal Approach – A Changing Trend: A Prospective Study

Pardhasaradhi¹,

Vital²,

Rao³

et al. 2015

jebmh

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High-energy tibial plateau fractures are infrequent and technically demanding to treat especially if those are shearing type, coronal plane, displaced fractures. The most widely used the Schatzker system of classification, [1] (Based on the AP radiograph) is more than likely to miss postero-medial and postero-lateral shear fractures, best visible on the lateral, than the AP radiograph. These fractures have recently been characterised by two studies, highlighting their clinical relevance [2,3] and showing that less invasive surgery and indirect reduction techniques are often inadequate. Hohl described unicondylar coronal plane splitting fractures of the medial tibial plateau, noted that these injuries be considered as fracturedislocations. Connolly and others have suggested that the mechanism involved in this fracture pattern is one of knee flexion, varus, and internal rotation of the medial femoral condyle. [4,5,6] Consistent among these and other authors is that the occurrence of this fragment is relatively unusual and that the use of a posteriorly based exposure with direct fracture visualization, anatomic reduction and absolute stability appears to result in satisfactory outcomes. Though variations of a postero-medial approach been previously described (by Trickey et al and also by Burks et al.,), more recently, Lobenhoffer et al described direct posterior exposure, Wang et al described postero-medial approach and Luo et al. described the approach for the management of posterior bicondylar tibial plateau fractures. [7,8] These approaches have been used in isolation or as a dual-incision approach for treating tibial plateau fractures. [9,10,11,12,13,14,15] PURPOSE: The purpose of this study is to describe this unfamiliar direct posterior surgical (Medial Gastrocnemius) approach to a general orthopod, highlighting the relevant anatomy and presenting our experience using this approach in treating a series of 15 patients with complex tibial plateau injuries with associated posterior shear fractures. MATERIALS AND METHODS: This prospective study included 15 cases of patients with mean age of 30 years (Age range 20 to 40 yr) who sustained high velocity posterior tibial plateau fracture-subluxations with or without associated Bicondylar fractures (Duparc, revised classification, Group-V: Postero-medial fracture and its associations). Surgical management includes by direct, dorsal approach and stabilisation with buttress plating and or also postero medial and or antero lateral approach as needed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Oxford Knee Score and Lyshom Score. RESULTS: The mean

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“…The authors refer to three studies specifically measuring average amounts of articular displacement of 10 mm to 11 mm and a surface area range of involvement of between 14% to 23% of plateau articular surface involvement [1,3,4], yet they acknowledge there are no long-term followup studies indicating conservative treatment provides acceptable results.…”

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confidence: 99%

Reply to the Letter to the Editor: Surgical Technique: Tscherne-Johnson Extensile Approach for Tibial Plateau Fractures

Johnson

2014

Clin Orthop Relat Res

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Posterolateral fragment characteristics in tibial plateau fractures

Cited by 17 publications

References 5 publications

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Optimal Surgical Management of High Velocity Posterior Tibial Plateau Fracture Subluxations (Duparc, Revised Classification, Group – V: Postero-Medial Fracture) by Direct, Dorsal Approach – A Changing Trend: A Prospective Study

Reply to the Letter to the Editor: Surgical Technique: Tscherne-Johnson Extensile Approach for Tibial Plateau Fractures

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