An anatomical study of three surgical approaches for posterolateral tibial plateau fracture

Abstract

Objective To compare 3 lateral surgical approaches (supra fibular head approach, di-gastric fibular head osteotomy approach, and combined lateral femoral epicondylar osteotomy and submeniscal approach) in exposing the posterolateral tibia plateau in cadaveric specimens. Methods The above 3 published surgical approaches -- supra-fibular-head approach (group A, n=8), digastric fibular head os-teotomy approach (group B, n=8), and lateral femoral epicondylar osteotomy approach (group C, n=8) -- were performed in 8 fresh-frozen cadavers. Once exposure of the posterolateral tibia plateau was achieved in each specimen, the backward pull distance of the structures above the fibular head and the exposure area of tibial condyle after retraction were measured. The model of posterolateral splitting fracture of the tibial plateau was established to observe the manipulative difficulties in reduction and fixation of the posterolateral tibial plateau fracture. Results The backward pull distance of the structures above the fibular head was 10.61±0.97 mm, 15.41±1.05 mm, and 20.72±1.35 mm in groups A, B and C respectively while the exposure area after retraction was 107.55±13.89 mm2, 155.86±10.74 mm2, and 197.46±13.52 mm2 in the 3 groups respectively, showing statistically significant differences between groups (P< 0.05). It was not convenient for the surgical approach in group A to process the posterior wall of posterolateral tibial plateau under direct vision while operation under direct posterior vision could be done in groups B and C, especially in group C where the operation was the most convenient. Conclusions All the 3 approaches can be used for reduction and fixation of the posterolateral tibial plateau fracture. The supra-fibular-head approach gives the smallest exposure range which is inconvenient for treatment of the posterior wall of the posterolateral condyle of the tibial plateau. The digastric fibular head osteotomy approach and lateral femoral epicondylar osteotomy approach provide larger exposure ranges which facilitate convenient reduction and fixation but lead to slightly larger operative trauma. Key words: Tibia; Knee joint; Fracture fixation, internal; Autopsy; Surgical approach