Posterolateral Transfibular Approach to Tibial Plateau Fractures: Technique, Results, and Rationale

Abstract

We describe a posterolateral transfibular neck approach to the proximal tibia. This approach was developed as an alternative to the anterolateral approach to the tibial plateau for the treatment of two fracture subtypes: depressed and split depressed fractures in which the comminution and depression are located in the posterior half of the lateral tibial condyle. These fractures have proved particularly difficult to reduce and adequately internally fix through an anterior or anterolateral approach. The approach described in this article exposes the posterolateral aspect of the tibial plateau between the posterior margin of the iliotibial band and the posterior cruciate ligament. The approach allows lateral buttressing of the lateral tibial plateau and may be combined with a simultaneous posteromedial and/or anteromedial approach to the tibial plateau. Critically, the proximal tibial soft tissue envelope and its blood supply are preserved. To date, we have used this approach either alone or in combination with a posteromedial approach for the successful reduction of tibial plateau fractures in eight patients. No complications related to this approach were documented, including no symptoms related to the common peroneal nerve, and all fractures and fibular neck osteotomies healed uneventfully.

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].…”

Morphological characteristics of split-depression fractures of the lateral tibial plateau (Schatzker type II): a computer-tomography–based study

“…Compared with plain radiographs, computed tomography (CT) scans can provide detailed information on intra-articular fractures. With the widespread use of CT, it has been found that in some cases, the fracture line may appear on the coronal plane and the split-depression fracture may be restricted in the posterolateral region, which is different from ordinary Schatzker type II fractures, as the visualisation of the fracture site was obstructed by the fibular head [8][9][10]. Inadequate vision or assessment of the fracture may lead to failure of primary fixation, and furthermore, secondary articular depression, valgus deformity and deterioration in the long-term [11].…”

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

“…An anterior or anterolateral approach has commonly been used. However, if the fracture line does not extend to the anterior tibial cortex, then osteotomy of the anterior tibial cortex might be required [11]. An anterior or anterolateral approach also cannot provide good visualisation of the posterior plateau because of the soft tissue structures of the posterolateral corner.…”