Open reduction and internal fixation of lateral tibial plateau fractures with free subchondral 2.7 mm screws

Abstract

Exact reconstruction of the depressed articular surface and stable subchondral fixation of the lateral tibial plateau (ORIF, "open reduction and internal fixation"). Tibial plateau fractures with involvement of the lateral column and depression of the articular surface. Critical soft tissue. Severe osteoporosis. Supine position, classical anterolateral approach, lateral submeniscal arthrotomy, visualisation of the fracture, osteotomy of the lateral tibial condyle. Reconstruction of the articular surface under visual control and temporary fixation with Kirschner wires. One or more 2.7 mm locking screws are placed subchondral for permanent stable fixation of the articular surface. If needed, the metaphyseal bone defect is filled with autologous or allogenic bone graft. The lateral tibial condyle is reduced and a3.5 mm (variable angle) locking compression plate applied. Closure of fascia and skin in layers. Free range of motion, in case of residual instability of the collateral ligaments varus-valgus stabilizing brace, partial weight-bearing of 10-15 kg for 8weeks, control computed tomography (CT) scan after 3months. Since February 2014, atotal of 23lateral tibial plateau fractures were treated using the described technique; 4patients were lost to follow-up and the 3‑month follow-up of 2patients is not completed yet. After an average of 167days, 11patients had no complaints. At approximately 3months postoperatively, 10patients had full range of motion, 3had aflexion deficit of at least 30°, and 2patients had residual instability of the medial collateral ligament. One postoperative superficial infection was noted. At the 3month CT, 10 of 17patients showed successful reduction without significant articular steps or anatomical malalignment.