The posterior inverted L-shaped approach would not involve osteotomy, tendotomy or division of muscles, while allowing satisfied visualization of the entire posterior aspect of tibial plateau and appropriate placement of hardware. This approach is a safe and effective way for the treatment of posterior bicondylar tibial plateau fractures.

Background:Pilon fractures are challenging to manage because of the complexity of the injury pattern and the risk of significant complications. The soft tissue injury and handling of the soft tissue envelope are crucial in pilon fracture outcomes. The purpose of this study was to evaluate the early rate of complications using the strategy of “soft tissue control” for operative treatment of complex pilon fractures.Materials and Methods:36 complex pilon fractures were treated with the “soft tissue control” strategy. Patients followed the standard staged protocol, anterolateral approach to the distal tibia, the “no-touch” technique and incisional negative pressure wound therapy for pilon fractures. Patients were examined clinically at 2-3 weeks and then 8 weeks for complications associated with the surgical technique.Results:All fractures were AO/OTA (Orthopaedic Trauma Association) type C fractures (61% C3, 22% C2 and 16% C1). Only one patient developed superficial infection and resolved with antibiotics and local wound care. None developed deep infection.Conclusions:The strategy of soft tissue control for treatment of pilon fractures resulted in relatively low incidence of early wound complications in patients with complex pilon fractures.

Crossing C(2) laminar screw internal fixation technique is simple, and is not limited by the position of the vertebral artery in the body of C(2). The laminar screw method avoids arterial injuries and also can be used as a salvage method after previous misinsertion. As all relevant structures are directly visualized during C(2) laminar screw placement, this kind of technique may be applicable to a large number of patients.