Use of a Midline Anterior Incision for Isolated Medial Tibial Plateau Fractures

Espinoza-Ervin, Christopher; Starr, Adam J.; Reinert, Charles M.; Nakatani, Tetsuya; Jones, Alan L.

doi:10.1097/bot.0b013e3181987908

Cited by 15 publications

(10 citation statements)

References 4 publications

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“…For fracture patterns combined with centroposterior lateral plateau coronal depression (Group 2, subgroups 7 and 8), the operative strategies vary widely. They include a posterior midline incision, 20 separate posteromedial and posterolateral incisions, 21 an extensive anterior midline incision, 22 a large medial incision, 19 or combined posteromedial and anterolateral dual incisions with intra-articular osteotomy, 23,24 and the use of arthroscopy assistance. 25 The authors prefer to use a single inverted L-shaped posteromedial incision in the prone position.…”

Section: Resultsmentioning

confidence: 99%

Schatzker Type IV Medial Tibial Plateau Fractures: A Computed Tomography–based Morphological Subclassification

Chang¹,

Zhang²,

Meng-wei³

et al. 2014

Orthopedics

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Schatzker type IV medial tibial plateau fractures have an unfavorable prognosis, likely due to the mechanism of injury (fracture-dislocation/subluxation type) and possibly due to the involvement of the posterolateral plateau, which is different from previously thought. The aim of this study was to propose a new subclassification of Schatzker type IV fracture patterns based on 2-dimensional (2-D) computed tomography and three-dimensional (3-D) reconstruction. The authors defined Schatzker type IV medial tibial plateau fractures as AO/OTA 41 type B fractures (partial articular), with partial or total medial plateau involvement, leaving at least the anterolateral quadrant intact. The images of 42 fractures (42 patients) were evaluated. The fractures were further anatomically divided into 2 groups: Group 1 were classic medial unicondylar fractures and Group 2 were more complicated variants involving both condyles, characterized by medial condyle fractures with lateral plateau extension, usually with articular impaction of the centroposterior lateral plateau. Twelve (29%) cases involved only the medial condyle, and 30 (71%) involved both the medial and lateral condyles. Twenty-nine (69%) cases demonstrated posterior coronal fractures. The most common patterns were bicondylar posteromedial plateau fractures with posterolateral quadrant depression (bicondylar posterior fractures: 14 cases, 33%) and total/subtotal medial condyle fractures with posterolateral quadrant depression (13 cases, 31%). The isolated unicondylar posteromedial split fracture was uncommon (2 cases, 5%). Computed tomography-based reconstruction enhances the understanding of fracture anatomy and the relationships between fracture fragments. In Schatzker type IV medial tibial plateau fractures, the involvement of posterolateral quadrants is common.

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Section: Resultsmentioning

confidence: 99%

Schatzker Type IV Medial Tibial Plateau Fractures: A Computed Tomography–based Morphological Subclassification

Chang¹,

Zhang²,

Meng-wei³

et al. 2014

Orthopedics

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“…Increasing familiarity with this combined approach for the treatment of bicondylar plateau fractures paralleled the widespread adoption of the posteromedial approach for isolated medial column injuries. 8,10,16 However, surgeons selecting the posteromedial approach to the tibial plateau often overlook its intrinsic limitations: (1) Difficulty neutralizing biomechanical forces necessary for fracture reduction while simultaneously obtaining the exposure required for placement of fixation; (2) Lack of direct visualization of the articular surface; and (3) Concomitant inability to address intraarticular pathology such as ligamentous or meniscal injury. 10 In their "Technical Trick" article published in JOT in 2009, Espinoza-Ervin and colleagues presented 2 cases which featured an anterior approach by medial parapatellar arthrotomy for the treatment of medial tibial plateau fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Benefits of the technique include simplicity, familiarity, and utility of the anterior medial parapatellar approach, adequate exposure for reduction and medial column plating, access and reduction of joint impaction, repair of meniscal and/ or ligament injuries and a functional scar. 10 We present a detailed description of the surgical technique and a retrospective review of clinical and radiographic outcomes from a series of 17 patients with these medial tibial plateau shear fracture treated with an anterior approach following a standardized protocol. The additional advantages of this approach include direct joint visualization, facilitating the evaluation and repair or reconstruction of all injured medial (MCL) and intra-articular soft-tissue structures responsible for knee stability (ACL, PCL, medial, and lateral menisci).…”

Section: Introductionmentioning

confidence: 99%

Anterior Midline Incision is a Safe and Effective Approach for High-energy Medial Shear Fractures of the Tibial Plateau

Rodriguez-Buitrago

Cereijo

Yusi

et al. 2020

Techniques in Orthopaedics

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Objective: We present a technical trick for surgical treatment of with (Schatzker IV) medial tibial plateau fractures treated with a standardized operative protocol with early radiographic and clinical outcomes.Methods: Skeletally mature patients with a medial tibial plateau fracture (Schatzker IV) admitted to an academic level 1 trauma center between 2002 and 2017 were identified by institutional database review. Screening of operative reports selected patients treated with a single anteromedial approach following a standard surgical protocol by a single surgeon. Data relevant to initial injury characteristics, patient comorbidities, operative management, and follow-up were extracted by chart review. Preoperative and postoperative clinical documentation and radiographs were examined to measure specific injury and outcome variables. Radiographic and clinical outcomes were validated by one fellowship-trained orthopedic trauma surgeon and 2 orthopedic trauma fellows.Results: Review of 335 patients with tibial plateau fractures during the study period identified a series of 17 high-energy, medial partial articular fractures that met the inclusion criteria. Injury pattern included articular depression in all patients, meniscal injury in 59%, ligamentous injury in 65% and none had compartment syndrome. Immediate radiographic analysis showed restoration of the articular surface, condylar width, and mechanical alignment for all patients. No patient experienced wound healing complications, soft tissue infection or skin necrosis. Median time to radiographic fracture consolidation was 12.9 weeks and ambulation without achieved at 18.9 weeks. Conclusions:The use of a standard anteromedial approach to the knee via medial parapatellar arthrotomy with full-thickness medial skin flap for isolated high-energy medial column tibial plateau fractures offers improved visualization and facilitates reduction and fixation of the lateral and anterior articular impaction while enabling immediate repair or reconstruction of associated meniscal and ligamentous (anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament) pathology. Short-term and mid-term follow-up demonstrates good clinical and radiographic patient outcomes. This approach is a safe and reliable option for treatment of this unique and challenging injury pattern.

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“…There are many surgical approaches to address the complex posterior tibialplatue fractures associated with posterior shear fractures. A midline approach with division of the patellar ligamentor even an osteotomy of the tibial tuberosity are used to treat these fractures but are associated with complications related to wound healing and seems very hostile for these fractures [3,4,11] . Posteromedial approach first described by lobenhoffer and later Fakler and Brunner developed direct posterior approach to address this main fragment [5][6][7][8][9] .…”

Section: Discussionmentioning

confidence: 99%

Role of posteromedial plating in medial condylar fractures of Tibia

Amar¹,

Hussain²

2020

Nat. J. Clin. Orthop.

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Introduction:The purpose of this study is to define "Role of Posteromedial Plating in medial condylar fractures of Tibia" Therefore, describing the surgical approach to a general orthopaedic surgeon, highlighting the relevant anatomy of posteromedial surgical approach and presenting our experience in treating patients with Posterior tibial shear fracture treating a series of 14 patients using posteromedial approach. Materials and methods: In our study of 14 patients who sustained high velocity posterior-medial tibial plateau fracture. The mean age was 42 years (range 30 to 50 yr). Posteromedia surgical approach used for fracture reduction and stabilisation with plate. The patients were followed up at regular interval postoperatively and Oxford Knee Score and Lyshom Score was used to assess final outcome. Results: 42 (range 40 to 44) was the average OKS score at the end of one year. The post-operative clinical measures were early non weight bearing, ROM to reduce post-operative complication & improve functional outcome. According to oks and lyshom scores the rate of post-operative complications & functional outcome was significantly better as evident by 100% showing good to excellent results at the time of full weight bearing. Conclusion: Buttress/Antiglide plate are usually needed to reduce the fractures anatomically in medial tibial plateau shear fractures which are otherwise irreducible by conventional approaches to achieving absolute stability and mobilise early, NWB, ROM of the knee joint to optimize the functional outcomes and minimise the complications, without the need for revision surgery.

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Use of a Midline Anterior Incision for Isolated Medial Tibial Plateau Fractures

Cited by 15 publications

References 4 publications

Schatzker Type IV Medial Tibial Plateau Fractures: A Computed Tomography–based Morphological Subclassification

Schatzker Type IV Medial Tibial Plateau Fractures: A Computed Tomography–based Morphological Subclassification

Anterior Midline Incision is a Safe and Effective Approach for High-energy Medial Shear Fractures of the Tibial Plateau

Role of posteromedial plating in medial condylar fractures of Tibia

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