Download PDF
J Knee Surg 2020; 33(07): 646-654
DOI: 10.1055/s-0039-1683927
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Modified Direct Posterior Midline Approach for the Treatment of Posterior Column Tibial Plateau Fractures

Zhaowei Yin   *
1   Department of Orthopaedic, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Wengbo Yang   *
1   Department of Orthopaedic, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Yanqing Gu
1   Department of Orthopaedic, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Qiangrong Gu
1   Department of Orthopaedic, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Chenyang Xu
1   Department of Orthopaedic, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Lei Yang
1   Department of Orthopaedic, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Chunzhi Jiang
1   Department of Orthopaedic, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Bin Liang
1   Department of Orthopaedic, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
› Author Affiliations Funding None.
Further Information

Publication History

06 June 2018

05 February 2019

Publication Date:
27 March 2019 (online)

    Permissions and Reprints

Abstract

The purpose of this study was to introduce a modified surgical approach for the treatment of posterior column tibial plateau fractures. Fifteen patients with posterior column fractures with or without other column fractures were included and treated with this approach between July 2015 and June 2016. The patients were followed up for 18 to 24 months (20.9 ± 1.8 months). Outcomes included neural or vascular injuries, wound complications, nonunion, plate loosening or breakage, and Hospital for Special Surgery (HSS) scores. Bone union was observed in all cases, and the average time for bone union was 13.5 ± 1.4 weeks (11–16 weeks). No neurovascular injuries, malunion, nonunions, or plate loosening or breakages were observed. The average HSS score was 94.7 ± 4.1 (range: 84–100). The modified direct posterior midline approach can provide excellent exposure and facilitate reduction and internal fixation of posterior column fractures of the tibial plateau, including split and depressed fractures. We expect that this approach can be used as a new effective method for managing complex posterior tibial fractures.

Keywords

tibial plateau fractures - posterior approach - classification - surgical approach

Note

This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.


* These authors contributed equally to this work.


 

  • References

  • 1 Urruela AM, Davidovitch R, Karia R, Khurana S, Egol KA. Results following operative treatment of tibial plateau fractures. J Knee Surg 2013; 26 (03) 161-165
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Chen P, Lu H, Shen H, Wang W, Ni B, Chen J. Newly designed anterolateral and posterolateral locking anatomic plates for lateral tibial plateau fractures: a finite element study. J Orthop Surg Res 2017; 12 (01) 35
    CrossrefPubMedSearch in Google Scholar
  • 3 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res 1979; 138 (138) 94-104
    PubMedSearch in Google Scholar
  • 4 Marsh JL, Slongo TF, Agel J. , et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007; 21 (10) S1-S133
    CrossrefPubMedSearch in Google Scholar
  • 5 Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 2010; 24 (11) 683-692
    CrossrefPubMedSearch in Google Scholar
  • 6 Chang SM, Hu SJ, Zhang YQ. , et al. A surgical protocol for bicondylar four-quadrant tibial plateau fractures. Int Orthop 2014; 38 (12) 2559-2564
    CrossrefPubMedSearch in Google Scholar
  • 7 Chen HW, Zhou SH, Liu GD. , et al. An extended anterolateral approach for posterolateral tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3750-3755
    CrossrefPubMedSearch in Google Scholar
  • 8 Yoon YC, Sim JA, Kim DH, Lee BK. Combined lateral femoral epicondylar osteotomy and a submeniscal approach for the treatment of a tibial plateau fracture involving the posterolateral quadrant. Injury 2015; 46 (02) 422-426
    CrossrefPubMedSearch in Google Scholar
  • 9 Yu B, Han K, Zhan C, Zhang C, Ma H, Su J. Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee 2010; 17 (05) 313-318
    CrossrefPubMedSearch in Google Scholar
  • 10 Pires RES, Giordano V, Wajnsztejn A. , et al. Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau. Injury 2016; 47 (10) 2320-2325
    CrossrefPubMedSearch in Google Scholar
  • 11 Chen HW, Luo CF. Extended anterolateral approach for treatment of posterolateral tibial plateau fractures improves operative procedure and patient prognosis. Int J Clin Exp Med 2015; 8 (08) 13708-13715
    PubMedSearch in Google Scholar
  • 12 Sun H, Zhai QL, Xu YF, Wang YK, Luo CF, Zhang CQ. Combined approaches for fixation of Schatzker type II tibial plateau fractures involving the posterolateral column: a prospective observational cohort study. Arch Orthop Trauma Surg 2015; 135 (02) 209-221
    CrossrefPubMedSearch in Google Scholar
  • 13 Corrales LA, Morshed S, Bhandari M, Miclau III T. Variability in the assessment of fracture-healing in orthopaedic trauma studies. [J] J Bone Joint Surg Am 2008; 90 (09) 1862-1868
    CrossrefPubMedSearch in Google Scholar
  • 14 Ranawat CS, Insall J, Shine J. Duo-condylar knee arthroplasty: hospital for special surgery design. Clin Orthop Relat Res 1976; 120 (120) 76-82
    PubMedSearch in Google Scholar
  • 15 Partenheimer A, Gösling T, Müller M. , et al. [Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation]. Unfallchirurg 2007; 110 (08) 675-683
    CrossrefPubMedSearch in Google Scholar
  • 16 Waldrop JI, Macey TI, Trettin JC, Bourgeois WR, Hughston JC. Fractures of the posterolateral tibial plateau. Am J Sports Med 1988; 16 (05) 492-498
    CrossrefPubMedSearch in Google Scholar
  • 17 Bermúdez CA, Ziran BH, Barrette-Grischow MK. Use of horizontal rafting plates for posterior elements of complex tibial plateau fractures: description and case reports. J Trauma 2008; 65 (05) 1162-1167
    CrossrefPubMedSearch in Google Scholar
  • 18 Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma 2005; 19 (02) 73-78
    CrossrefPubMedSearch in Google Scholar
  • 19 Brunner A, Honigmann P, Horisberger M, Babst R. Open reduction and fixation of medial Moore type II fractures of the tibial plateau by a direct dorsal approach. Arch Orthop Trauma Surg 2009; 129 (09) 1233-1238
    CrossrefPubMedSearch in Google Scholar
  • 20 Connolly JF. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma 2005; 19 (07) 508 , author reply 508
    PubMedSearch in Google Scholar
  • 21 Ebraheim NA, Lu J, Hao Y, Biyani A, Yeasting RA. Anterior tibial artery and its actual projection on the lateral aspect of the tibia: a cadaveric study. Surg Radiol Anat 1998; 20 (04) 259-262
    CrossrefPubMedSearch in Google Scholar
  • 22 Heidari N, Lidder S, Grechenig W, Tesch NP, Weinberg AM. The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau: a cadaver study. J Orthop Trauma 2013; 27 (04) 221-225
    CrossrefPubMedSearch in Google Scholar
  • 23 Sun H, Luo CF, Yang G, Shi HP, Zeng BF. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol 2013; 23 (07) 809-818
    CrossrefPubMedSearch in Google Scholar