Techniques for management of hyperextension bicondylar tibial plateau fractures.

Abstract

Hyperextension bicondylar tibial plateau (HEBTP) fractures are a subset of tibial plateau fractures that primarily affect the sagittal alignment of the tibial condyles. They comprise less than 20% of all bicondylar injuries [ [1] Gonzalez LJ Lott A Konda S Egol KA. The Hyperextension Tibial Plateau Fracture Pattern: A Predictor of Poor Outcome. J Orthop Trauma. 2017; 31: e369-e374 Crossref PubMed Scopus (13) Google Scholar ]. They have been described following both high and low energy mechanisms [ 1 Gonzalez LJ Lott A Konda S Egol KA. The Hyperextension Tibial Plateau Fracture Pattern: A Predictor of Poor Outcome. J Orthop Trauma. 2017; 31: e369-e374 Crossref PubMed Scopus (13) Google Scholar , 2 Firoozabadi R Schneidkraut J Beingessner D Dunbar R Barei D. Hyperextension Varus Bicondylar Tibial Plateau Fracture Pattern: Diagnosis and Treatment Strategies. J Orthop Trauma. 2016; 30: e152-e157 Crossref PubMed Scopus (22) Google Scholar , 3 Zhao R Lin Z Long H Zeng M Cheng L Zhu Y. Diagnosis and treatment of hyperextension bicondylar tibial plateau fractures. J Orthop Surg Res. 2019; 25 (14): 191 Crossref Scopus (6) Google Scholar , 4 Chouhan DK Chand Saini U Kumar Rajnish R Prakash M Complex bicondylar tibial plateau fractures with reversed tibial slope - Our experience with a fracture-specific correction strategy. Trauma Case Rep. 2019; 28100256 Google Scholar ]. In these injuries, a combined axial and varus load is imparted to the knee which results in compressive forces to the anterior portion of the tibial plateau and tension across the posterior plateau. Given the varus alignment of the knee and tether of the posterolateral knee capsuloligamentous complex, there is asymmetric concentration of force to the medial plateau resulting in a characteristic injury pattern that is often more severe on this side [ 5 Chiba T Sugita T Onuma M Kawamata T Umehara J. Injuries to the posterolateral aspect of the knee accompanied by compression fracture of the anterior part of the medial tibial plateau. Arthroscopy. 2001; 17: 642-647 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 6 Yoo JH Kim EH Yim SJ Lee BI. A case of compression fracture of medial tibial plateau and medial femoral condyle combined with posterior cruciate ligament and posterolateral corner injury. Knee. 16. 2009: 83-86 Google Scholar , 7 Tomás-Hernández J Monyart JM Serra JT Vinaixa MR Farfan EG García VM Feliu EC. Large fracture of the anteromedial tibial plateau with isolated posterolateral knee corner injury: case series of an often missed unusual injury pattern. Injury. 2016; 47: S35-S40 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar ]. Regardless of mechanism, a common characteristic of these injuries is anteromedial metaphyseal comminution and loss of the normal posterior slope of the medial, and often, lateral side. The average anatomic medial proximal tibial angle (MPTA) is 87o (range 85-900); the average posterior proximal tibial angle (PPTA) is 810 (range 77-84o) [ [8] Paley D. Normal Lower Limb Alignment and Joint Orientation. In Paley D, editor. Principles of Deformity Correction 1st ed. Berlin: Springer-Verlag; 2003, p. 1-18. Google Scholar ]. Anatomic reduction of the articular surface and restoration of sagittal and coronal alignment must be achieved at surgery and maintained until union.