Advances in selection of surgical approach and internal fixation for posterolateral tibial plateau fractures

Abstract

There haven't been an uniform criterion for the treatment of posterolateral tibial plateau fracture till now. For this type of fractures, surgical approaches are divided into two main parts, non-osteotomy approach and osteotomy approach. The non-osteotomy approach includes posterolateral approach, anterolateral approach, lateral approach, posteromedial approach and posterior approach. Each of them includes advantage and disadvantage. Posterolateral approach is the most effective exposure of posterolateral tibial plateau fracture. Satisfactory reduction and buttress fixation could be achieved under direct view. Posterolateral tibial plateau fracture could also be exposed from the gap between fibular head and posterolateral tibial plateau via anterolateral approach, but the raft plate should be placed backwardly to achieve the best fixation result. With a single lateral incision of the tibial plateau, the anterolateral and posterolateral plateau fragments could be fixed simultaneously through the anterolateral and posterolateral interval of the deep tissue. The anatomy of the posteromedial approach is simpler, however, it's difficult to view all the comminuted fragments of the posterolateral tibial plateau. The injury risk of popliteal blood vessels and nerves is relatively high, therefore it's rarely used right now. The osteotomy approach includes fibular head, lateral femoral epicondyle and tibial Gerdy tuberosity osteotomy. The osteotomy approaches of lateral femoral epicondyle and tibial Gerdy tuberosity are usually used in the cases associated with the anterolateral approach of the knee. The best view of the posterolateral tibial plateau could be obtained via the fibular head osteotomy approach. But the extra damage is too severe to recommend routinely. On the other hand, there are several fixation options when posterolateral tibial plateau fractures are treated. The buttress plate was verified to be the best fixation method and the rim plating provided a novel idea for this fracture pattern. The fibular support is a reliable method for posterolateral compression fracture as well. We will summarize the selection of surgical approaches and internal fixation methods to provide a reference for the clinical doctors. Key words: Tibial plateau; Posterolateral; Surgical approach; Osteotomy; Fracture fixation, internal