Tibial plateau fractures - standard and specific surgical approaches

Abstract

PURPOSE: Every surgeon faces multiple problems when treating tibial plateau fractures. The bony and soft tissue anatomy presents few peculiarities. Thin soft tissue envelope has impaired healing capacity and knee joint function is complex and difficult to restore. Congruency of the joint surfaces, correct load distribution, ligamentous stability and a normal biological quality of the cartilage are necessary prerequisites for the normal joint function. Restoration of these parameters must be the main therapeutic goal in any intraarticular fractures of the proximal tibia. The aim of article is to describe in details the approaches to the tibial plateau and the necessity to apply them depending on the different type of fracture. MATERIAL AND METHODS: A total of 21 patients with tibial plateau fractures were followed-up in the Department of Orthopaedics and Traumatology, St. Anna University Hospital of Varna, during a 2-year period (2010-2012). According to the fracture pattern, primarily anterolateral and posteromedial approach or both were used. Anterolateral approach was applied in six patients, posteromedial - in two, combined (anterolateral and posteromedial) - in six, ventral midline and posterolateral (transfibular) - in three each, and direct posterior - in one case. RESULTS: The average time to union of all the fractures was 3.5 months. Nineteen patients had satisfactory articular reduction (d2 mm step/gap) and two patients presented with articular step of 4 mm. All the patients demonstrated satisfactory coronal and sagittal alignment. Dimensions of knee mobility were extension of 2 and flexion of 112°. There was no anterior, posterior, varus, or valgus knee instability. CONCLUSION: High-energy tibial plateau fractures require good surgeon's knowledge of knee anatomy and possible approaches. This enables the selection of the most appropriate operative technique, a standard or a specific one, especially in complex bicondylar fractures. Scripta Scientifica Medica 2013; 45(3): 74-81.