A novel universal medial approach for difficult posteromedial tibial plateau fractures: a prospective case series

Abstract

Background: Tibial plateau fractures are considered to be one of the most common fractures with an increasing incidence of motor vehicle accidents. Posteromedial fracture, in particular, is considered a more challenging case. Combination of posteromedial fragment fracture with central articular depression or medial condyle fracture make it much more difficult to reduce and adequately fix the fractured fragments. The aims of this study were to describe a new extensile medial approach for the management of different types of tibial plateau fractures with posteromedial fragments and to evaluate results using this approach. Methods: Between January 2015 and January 2017, 15 patients with Schatzker IV, V, or VI fractures, in combination with a posteromedial fragment, were operated for open reduction of the fracture with restoration of the articular surface alignment. Fixation was done by double plate osteosynthesis. Complete healing time and knee-function scores were recorded in the follow-up period. Results: The average age of patients was 41.8 yr; the mean follow-up period was 30 mo. One patient had superficial wound dehiscence and was treated conservatively. No patients with knee instability or loss of reduction were reported. Conclusions: The posteromedial approach offers a very good access to view, reduce, and fix difficult posteromedial fractures together with comminuted tibial plateau fractures without the need for dissection of the neurovascular bundle in the fossa or soft-tissue injury. Level of Evidence: Level IV.