Posterolateral Tibial Plateau Depression Fracture Reduction and Fixation: A Novel Approach

Abstract

Introduction: Reduction and fixation of pure depression fractures of the posterolateral tibial plateau are technically challenging. Surgical approach and exposure are complicated by the presence of the fibular head and important ligamentous, and neurovascular structures. Current lateral-based plate options may also leave the elevated articular surface unsupported and risk subsequent collapse. Materials and Methods: We present a case of a 37-year-old female rugby player with acute isolated posterolateral tibial plateau depression fracture. We utilized a novel surgical strategy that included a standard anterolateral approach, indirect reduction of the depressed articular surface using a targeted lateral tibial plateau osteotomy, and fixation with anterolateral periarticular and 1/3 tubular plate used in “blade” manner. The reduction was confirmed by fluoroscopy and arthroscopy. Fixation was augmented by femoral strut allograft to fill subsequent defect. Results: Postoperative progress was uncomplicated. At a 3-month review, the fracture was united and the patient had a full range of knee motion and function. Conclusions: This article presents a technique for reduction and stabilization of posterolateral articular impaction fractures while minimizing potential neurovascular and soft tissue complications.