An osteotomy anterolateral approach for lateral tibial plateau fractures merged with relatively simple and intact posterolateral corner displacement

Journal of Orthopaedic Surgery and Research

Ai-min Chen¹  Tian-wen Ye¹  De-peng Meng¹ 

[1] Department of Orthopedic Surgery, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai 200003, China

关键词: Indication and techniques;    Anterolateral approach;    Posterolateral corner displacement;    Lateral tibial plateau fractures;   

Others  :  813489
DOI  :  10.1186/1749-799X-9-26

 received in 2013-11-06, accepted in 2014-03-12,  发布年份 2014

【 摘 要 】

Introduction

This study investigates the safety and efficacy of anterolateral (AL) osteotomy for the treatment of lateral tibial plateau fractures merged with relatively simple and intact posterolateral (PL) corner displacement and screens applicable patients.

Methods

Totally, 11 patients with lateral tibial plateau fractures involving the PL corner were included in this study. Of them, seven patients sustained their injuries from motor vehicle accidents (MVAs), three from sports and one from fall from height. All of them received open reduction and internal fixation through the AL approach. Operation time, incision length, range of motion (ROM), Hospital for Special Surgery (HSS) knee score, time of union and complications were retrospectively reviewed. Tibial plateau angle (TPA), lateral posterior slope angle (PSA) and articular step-off reduction after surgery were examined by a radiograph technique.

Results

Statistically, the means of operation time, incision length, ROM and follow-up period were 82 min, 11 cm, 97° and 27 months, respectively. Three patients had slight complications: superficial infection, hardware irritation and secondary valgus deformity, without severe neural or vascular injuries, which revealed the safety and efficacy of the PL treatment. The average HSS knee score was 91.2 (range 86–96). Reduction (mean TPA 87.2° and mean PSA 8.3°) was satisfactory in 10 patients, except for one patient with a radiographic articular step-off of 5 mm (case 10).

Conclusions

The AL approach is safe and effective for lateral tibial plateau fractures involving the PL corner, especially for fractures merged with simple and intact PL corner displacement (depression and/or split).

【 授权许可】

   
2014 Meng et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 2.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Waldrop JI, Macey TI, Trettin JC, Bourgeois WR, Hughston JC: Fractures of the posterolateral tibial plateau. Am J Sports Med 1988, 16:492-498.
• [2]Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L: Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007, 21:S1-S133. doi:00005131-200711101-00001
• [3]Hsieh CH: Treatment of the posterolateral tibial plateau fractures using the anterior surgical approach. Int J Biomed Sci: IJBS 2010, 6:316-320.
• [4]Solomon LB, Stevenson AW, Lee YC, Baird RP, Howie DW: Posterolateral and anterolateral approaches to unicondylar posterolateral tibial plateau fractures: a comparative study. Injury 2013, 44:1561-1568.
• [5]Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, Yu GR: Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg 2009, 129:955-962. doi:10.1007/s00402-009-0829-5
• [6]Chen WT, Zhang YQ, Chang SM: Posterolateral approach for plating of tibial plateau fractures and the risk of injury to the anterior tibial vessels. J Orthop Trauma 2013, 27:e228-e229. doi:10.1097/BOT.0b013e31829ff3e9
• [7]Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zeng BF: Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee 2012, 19:94-98. doi:S0968-0160(11)00030-5
• [8]He XF, Ye PH, Hu Y, Huang L, Zhang F, Liu GY, Ruan YP, Luo CF: A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures. Arch Orthop Trauma Surg 2013, 133:23-28. doi:10.1007/s00402-012-1632-2
• [9]Carlson DA: Posterior bicondylar tibial plateau fractures. J Orthop Trauma 2005, 19:73-78. doi:00005131-200502000-00001
• [10]Georgiadis GM: Combined anterior and posterior approaches for complex tibial plateau fractures. J Bone Joint Surg (Br) 1994, 76:285-289.
• [11]De Boeck H, Opdecam P: Posteromedial tibial plateau fractures. Operative treatment by posterior approach. Clin Orthop Relat Res 1995, 320:125-128.
• [12]Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, Benirschke SK: Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am 2006, 88:1713-1721. doi:88/8/1713
• [13]Tao J, Hang D, Wang Q, Gao W, Zhu L, Wu X, Gao K: The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee 2008, 15:473-479. doi:S0968-0160(08)00122-1
• [14]Tscherne H, Lobenhoffer P: Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res 1993, 292:87-100.
• [15]Insall JN, Ranawat CS, Aglietti P, Shine J: A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am 1976, 58:754-765.
• [16]Khan RM, Khan SH, Ahmad AJ, Umar M: Tibial plateau fractures. A new classification scheme. Clin Orthop Relat Res 2000, 375:231-242.
• [17]Lobenhoffer P: Posterolateral transfibular approach to tibial plateau fractures. J Orthop Trauma 2011, 25:e31. doi:10.1097/BOT.0b013e31820b809a
• [18]Yu B, Han K, Zhan C, Zhang C, Ma H, Su J: Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee 2010, 17:313-318. doi:S0968-0160(10)00003-7
• [19]Frosch KH, Balcarek P, Walde T, Sturmer KM: A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma 2010, 24:515-520. doi:10.1097/BOT.0b013e3181e5e17d