Treatment of posterolateral tibial plateau fractures with a rotational support plate and special pressurizer: technical note and retrospective case series

Abstract

Background In tibial plateau fractures, the posterolateral segment of the tibia plateau is frequently affected and challenging to treat. Although there are many surgical approaches and fixation methods for the treatment of these fractures, all of these methods have limitations. We designed a new rotational support plate (RSP) and a special pressurizer that can fix the fracture directly via the anterolateral approach. This method is advantageous because it leads to little trauma, involves a simple operation, and has a reliable fixation effect. This study details the technique of treating these fractures with the RSP and special pressurizer and provides the outcomes. Methods From May 2016 to January 2019, the data of 12 patients with posterolateral tibial plateau fractures treated with the RSP and special pressurizer in our hospital were retrospectively analyzed. Postoperative rehabilitation was advised, knee X-rays were taken at follow-ups, and fracture healing, complications, and knee range of motion were assessed. The Hospital for Special Surgery (HSS) knee score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to evaluate knee function at the last follow-up. Results The average follow-up time of all patients was 16.5 months (range, 12–25 months). The average bony union time was 3.2 months (range, 3–4.5 months). At the last follow-up, the average knee range of motion was 138° (range, 107–145°). The average HSS score was 91 (range, 64–98). The average KOOS Symptoms score was 90 (range, 75–96). The average KOOS Pain score was 91 (range, 72–97). The average KOOS ADL score was 91 (range, 74–97). The average KOOS sport/recreation score was 83 (range, 70–90). The average KOOS QOL score was 88 (range, 69–93). Skin necrosis, incision infections, and fixation failure did not occur during the follow-up period. Conclusions With our newly designed RSP and special pressurizer, posterolateral tibial plateau fractures can be easily and effectively reduced and fixed through the anterolateral approach, which serves as a novel treatment for posterolateral tibial plateau fractures.

Surgical exposure to posterolateral quadrant tibial plateau fractures: an anatomic comparison of posterolateral and posteromedial approaches

“…There are a sort of surgical excisions used for exposing PL tibial plateau, including conventional AL approach, extended lateral approach, trans-fibular-neck approach, supra-fibular-head approach, and arthroscopy-assisted method [18][19][20]. As no plate was specially designed for posterolateral fractures, several authors had introduced newly designed plates for fixation, including AL approach and PL approach [21][22][23]. Giordano et al [20] proposed a hoop plating technique for the management in cases of extensive posterior tibial plateau articular surface fracture with posterior cortical wall ruptured.…”

“…Cho et al [18] had reported using a rim plate in combination with LCP for fixation of the PL fragment via modified anterolateral approach. Chen et al [21] had designed a rotational support plate and special pressurizer for fixation of the PL fragment directly via the AL approach. However, it is still the mainstream of surgical therapy to expose the fracture through a posterior approach, reduce the fracture, and fix it with a buttress plate.…”