High-energy fractures of the proximal tibia with extensive fragmentation of the posterolateral (PL) quadrant of the tibial plateau are challenging to manage. Herein, we present a review of the literature on the patterns and options of approach and fixation of the PL fragment of the tibial plateau to optimize the treatment of this specific injury pattern. We searched PubMed (1980–May 2020) to identify and summarize the most relevant articles evaluating both the morphology and treatment recommendations, including the choice of approach and fixation strategy, for the PL tibial plateau fracture. We found PL fragment can present in several patterns as a pure split, split depression, contained pure depression, and noncontained depression (rim crush), which are mostly determined by the position of the knee and the force magnitude applied during the course of the accident. Based on previous concepts described by Schatzker and Kfuri, we suggest a simplified treatment algorithm highlighting the two concepts (buttressing and containment) used for plating the PL tibial plateau fragments. Based on the available current evidence, we propose an algorithm for these two morphological types of PL tibial plateau fracture. Shear-type fractures need buttressing (the “rule of thumb”), whereas noncontained peripheral rim-type fractures need peripheral repair and containment. Contained pure depression fractures are not frequent and need percutaneous-assisted elevation and subchondral rafting, either controlled by fluoroscopy or arthroscopically. It is believed that such an approach would simplify their assessment and preoperative planning and would assist the clinicians to appreciate and manage more consistently these complex injuries.

An osteochondral fracture of the posterolateral tibial plateau associated with an anterior cruciate ligament (ACL) injury in a 24-year-old boy is reported. Anterior cruciate ligament rupture is accompanied by bone contusions resulting from the impact of the posterolateral tibial plateau on the anterior part of the lateral femoral condyle. The osteochondral fracture of the posterolateral tibial plateau matched the site where the bone bruise is observed.

No abstract

Determinados padrões de fratura do planalto tibial podem representar um quadro atípico de luxação ou subluxação do joelho, cuja suspeição diagnóstica pode não ser óbvia na avaliação inicial, especialmente se o joelho estiver reduzido nos exames de imagem. A associação entre a fratura pósterolateral do planalto tibial e as lesões do ligamento cruzado anterior, do ligamento colateral medial e do menisco lateral é relativamente frequente. Alguns pacientes podem apresentar um padrão raro de depressão articular na região póstero-lateral do planalto tibial, em associação com a lesão do ligamento cruzado anterior, que se assemelha à mordida de maçã, razão pela qual foi denominado “apple-bite-fracture”. O objetivo do presente estudo é descrever um quadro atípico de luxação de joelho, acompanhado por um padrão ainda mais raro de fratura, onde há destacamento de um fragmento osteocondral por forças de cisalhamento, entendido como uma variação do padrão “apple-bite”, e seu tratamento com a realização da osteotomia do epicôndilo lateral do fêmur.