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

De-Peng Meng,Tian-Wen Ye,Ai-Min Chen,De Peng Meng ,Tian Wen Ye ,Ai Min Chen

doi:10.1186/1749-799x-9-26

Abstract

IntroductionThis 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.MethodsTotally, 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.ResultsStatistically, 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).ConclusionsThe 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).

Highlights

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
The suggested treatment of PL plateau fractures is the use of the posterior approach for anatomical reduction and rigid fixation, as the posterior approach is believed to be easy for full exposure and surgical manipulations [4,5,6,7,8]
17 cases treated with open reduction and internal fixation through the anterolateral approach were included in the study (Table 1)

Summary

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. Based on the classification system of the AO Foundation and Orthopaedic Trauma Association (AO/OTA) [2], a PL tibial plateau fracture can be classified into 41-B1.1 (4), 41-B3.1(2) and 41-B2.2(4). This fracture has the following features: the mainly displaced fragment is located. The suggested treatment of PL plateau fractures is the use of the posterior approach for anatomical reduction and rigid fixation, as the posterior approach is believed to be easy for full exposure and surgical manipulations [4,5,6,7,8]. The posterior approach can lead to considerable risks of soft tissue injuries, such as paresthesia (12.5%–60%) [5,9,10], skin complications (14%) [11], vascular injury (20%) [9,12] and flexion contracture (50%) [10,13]

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Conclusion