Fibular head osteotomy: A new approach for the treatment of lateral or posterolateral tibial plateau fractures

Low-energy fracture of posterolateral tibial plateau

“…In addition, there is a higher risk of injury to the peroneal nerve along with a risk of developing pseudoarthrosis at the osteotomy site. 6 To avoid the fibular neck osteotomy, Yu et al 13 used the same lateral approach, but in his series one-third of the anterior fibular head was cut off longitudinally with the collateral ligament intact. However, the most important problem is that both of the transfibular and partial transfibular approaches are more suitable for the lateral buttress plate fixation, which has proven to be less stable than the posterior buttress plate in a biomechanical test.…”

“…To prevent postoperative instability of the proximal tibiofibular joint, the fibular articular facet and related ligaments attached to the posterior aspect of fibular head were protected. As mentioned earlier, Yu et al 13 cut off the anterior part of the fibular head through a lateral approach to expand the operative field but care should be taken to protect the fibular collateral ligament and the capsular of proximal tibiofibular joint, which are close to the osteotomy site. We chose to remove the posteromedial part of the fibular head, which has a minimal amount of ligament attachments.…”

A new anatomic locking plate for the treatment of posterolateral tibial plateau fractures

“…Many authors recommend surgical treatment to restore joint congruity and mechanical stability and further guarantee the best prognosis [4, 5]. However, the operative treatment of posterolateral tibial plateau fractures remains a challenge due to the fibular head and ligamentous structures that impede adequate exposure of the posterolateral joint surface.…”

“…However, the operative treatment of posterolateral tibial plateau fractures remains a challenge due to the fibular head and ligamentous structures that impede adequate exposure of the posterolateral joint surface. Although many approaches have been reported [4, 6–9] to achieve appropriate exposure, there is no general consensus.…”

An extended anterolateral approach for posterolateral tibial plateau fractures

“…Third, for some patients with combined posterolateral and anterolateral fractures, two surgical positions and two plates are needed in the posterolateral approach, which potentially increases both the surgical duration and difficulty. To solve this problem, Yu et al [16] suggested total or partial resection of the fibular head to fully expose the posterolateral tibial plateau; however, this approach was shown to increase local injury and affect joint instability.…”