Posteromedial Plate as Strategy for Fixation of Posterior Column of Tibial Plateau Fracture

Abstract

Background:A posteromedial tibial plateau fracture is considered a challenging injury pattern of the tibial plateau. Fracture line lies in the coronal plane leading to separation of a posteromedial fragment of variable size. This type of fracture is not rare, but it has been underappreciated previously.This study is aiming to spot light on posteromedial approach as new concept in treatment of tibial plateau fracture as regarding to clinical and radiological outcome and to assess its surgical efficacy and advantages in such cases and to show is it beneficial to the patients or not? Patient and Methods:This is a prospective study that included 15 consecutive patients (13 males & 2 females) with closed posteromedial tibial plateau fractures who had undergone open reduction and internal fixation through a posteromedial approach by plate and screws between May 2019 and September 2019. Our protocol in follow up ranged from three to six months postoperative. Results:In our study, the total clinical score according to the Rasmussen system was excellent in 8 patients (53.3%) and good in 7 patients (46.7%). As for complications, one case presented at the 3rd day postoperative with signs of compartment syndrome followed by superficial infection. The patient improved with conservative treatment with no need for surgical intervention. Conclusion:The posteromedial approach in managing posteromedial tibial plateau fracture is considered a safe and efficient approach. It allows perfect visualization and reduction of the displaced fragments. This approach uses an intermuscular plane without exposure of the neurovascular bundle.