Abstract
Introduction Conventional anterolateral surgical approach to the lateral tibial condyle has been well studied and proven safe. However, this approach does not provide adequate visualization for performing a good quality osteosynthesis in fractures located in the posterior segment of the lateral condyle. Purpose of the investigation was a rationale of plate implantation technique on the posterior surface of the lateral tibial condyle from the posterior approach with anatomical and clinical demonstration of its technical feasibility and safety. Materials and methods The study was conducted on 10 knee joints of six unfixed cadavers. We implanted a T-plate on the posterior surface of the lateral tibial condyle using a posterior surgical approach. After that soft tissues were dissected to explore the exact location and the distances between the plate and crucial anatomic structures of the region. Five patients underwent surgical treatment of tibial plateau fractures 41C3 type following AO/OTA classification or Schatzker classification type V using the described method. The patients were followed-up for nine months after surgery. Results were evaluated using the KSS and Lysholm scales. Results The study on cadavers showed safety and feasibility of the surgical technique developed. We did not encounter specific complications associated with posterior plate implantation. All fractures healed after nine months postsurgery. The functional outcomes according to KSS scale were excellent in four cases and good in one case; according to Lysholm scale, three were excellent, one good and one fair outcome. Discussion In spite of the simplicity of the conventional anterolateral approach, many investigators tend to use different modifications of posterior approaches for the posterior lateral tibial condyle fixation. This method provides better reduction and fixation using a buttress plate. Our investigation showed safety and feasibility of this technique for fixation of the posterior segment of the lateral tibial condyle. The technique proposed, if performed properly, provides safe and accurate osteosynthesis and prevents secondary displacements of fragments in the rehabilitative period.
Highlights
Conventional anterolateral surgical approach to the lateral tibial condyle has been well studied and proven safe
In a line with current notions about plating that implies an accurate reduction of bone fragments, including the articular surface, there is a clear tendency to use posterior surgical approaches for osteosynthesis of posterior tibial plateau fractures that provide the shortest way to the area of main bone lesions, their good visualization and the necessary conditions for placement of posterior buttress plates [9–14]
T-plate implanted on the posterior surface of the lateral tibial condyle what is presented in the photo of the preparation (Fig. 4)
Summary
Conventional anterolateral surgical approach to the lateral tibial condyle has been well studied and proven safe This approach does not provide adequate visualization for performing a good quality osteosynthesis in fractures located in the posterior segment of the lateral condyle. If the location of the main bone fragments is in the posterolateral or posterior parts of the lateral tibial condyle, this approach does not provide enough visualization which is required for accurate reduction and safe fixation of the fracture In particular, it does not allow osteosyntesis with a buttress plate that would prevent a posterior migration of the fragments [1, 4, 8]. The most commonly used among the posterior approaches to the lateral tibial condyle are the inverted L-shaped [9] and direct posterior approaches to the posterior parts of this condyle [15]
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