Direct Posterior Approach for Treatment of Posteromedial Fractures of the Tibial Plateau

Abstract

Fractures of the tibial plateau that have an associated, displaced posteromedial fracture pattern are difficult to reduce and fix adequately through conventional surgical approaches. The direct posterior approach to posteromedial fractures of the tibial plateau, with the patient in a prone position, has been used to overcome limitations related to conventional posteromedial approaches. The posterior approach allows for fracture reduction by hyperextension of the knee through axial traction over a surgical bump. The technique allows the direct visualization of posteromedial fractures of the tibial plateau without the need for dissection of the neurovascular bundle, and for placement of an antiglide buttress plate at the apex of the posteromedial fracture fragment. Patients undergoing fracture repair through the posterior approach can typically be mobilized on the first day after their surgery with functional rehabilitation and restricted weight bearing for 8 to 10 weeks postoperatively.