OUTCOME OF THE POSTERIOR APPROACH IN MANAGEMENT OF POSTERIOR TIBIAL PLATEAU FRACTURES: CASE SERIES STUDY

Abstract

Background:. Complex tibial plateau fracture management remains clinically challenging. In recent years, a ‘‘three-column fixation’’ technique was developed to treat the multiplanar complex tibial plateau fractures, which is based on three-dimensional understanding of the fractures. 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.Objective: Evaluate the clinical and radiologic efficacy of use of posterior approaches to tibial plateau fractures whether alone or combined with other approaches sequentially or staged for complex tibial plateau fractures with posterior involvement.Patients and methods: this study included twenty seven consecutive patients with tibial plateau fractures involving the posterior column in Orthopaedic Department, Ain Shams University Hospitals-Egypt in the period between August 2016 and August 2018. Cases underwent Lobenhoffer approach for the posteromedial fragment, or posterolateral approach with or without fibula osteotomy for posterolateral fragment fixation. Patients were evaluated radio logically immediately postoperative, at 3, 6, 12, 18 months by serial anteroposterior and lateral x- rays of knee with comparison with preoperative data.Results: The cases were 4 femalesand 23 males, with age range between18-46 years. There was a significant improvement after the surgery regarding the following parameters; pain, extension lag, antero-posterior stability, medio-lateral stability, total range of Flexion, alignment (Varus & Valgus) and Walking distribution. The results showed that 7.4% of the patients had Knee society score (KSS) of 70, 18.5% of the patients had a score of 75, while 29.6% of the patients had a score of 80, only 3.7% of the patients had a score of 85; in addition to 11.1% of the patients had a score of 90, 3.7% of the patients had a score of 95, and 25.9% of the patients had a score of 100.Conclusion: Posterior approaches to tibial plateau fractures whether alone or combined with other approaches was associated with good outcomes along the duration of postoperative follow up and should be advised for management of tibial plateau fractures.