Posterior Coronal Plating of Bicondylar Tibial Plateau Fractures Through Posteromedial and Anterolateral Approaches in a Healthy Floating Supine Position

Abstract

Bicondylar tibial plateau fractures pose a significant challenge for treating surgeons. If the articular surface of the medial plateau has a second split component in the posterior coronal plane, it is difficult to get direct visualization and ensure plate fixation when the patient is in the supine position. Using a technique in which a single preparation and draping of both legs is needed, patients were operated on using a healthy floating supine position maneuver through dual posteromedial and anterolateral incisions and triple plate fixations. By flexing and adducting the contralateral healthy hip over the injured leg, more lateral rotation of the fractured knee can be achieved, providing better access and visualization of the posterior medial plateau using a posteromedial gastrocnemius approach.

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

“…However, it is not enough for bilateral plates to stabilize a tibial plateau fracture with four quadrant involvement, which usually contains at least four main articular-fragments and cortical-column ruptures. Chang et al [7] reported using additional reconstruction plates to stabilize the coronal posteromedial and posterolateral quadrant fragments. With the combination of a heavy lateral locking plate and multi medial-posterior small antiglide plates, good results were achieved in 12 patients in the preliminary report [7].…”

“…Chang et al [7] reported using additional reconstruction plates to stabilize the coronal posteromedial and posterolateral quadrant fragments. With the combination of a heavy lateral locking plate and multi medial-posterior small antiglide plates, good results were achieved in 12 patients in the preliminary report [7]. Zhai et al [26] reported their experience with applying multi-plates (3-, 4-, and 5-plates) for severe and complicated bicondylar tibial plateau fractures in 26 young patients.…”

“…The contralateral hip is flexed, adducted, with the pelvis rotated towards the injured side. This manoeuver places the patient's pelvis and lower trunk in a semi-lateral position, and the injured leg is rotated laterally, allowing access to the posterior aspect of the knee [7]. A scrubbed assistant holds We first start from the posteromedial approach.…”

“…A scrubbed assistant holds We first start from the posteromedial approach. An inverted L-shaped incision is made, centring the horizontal limb at the popliteal crease [4,7,14]. The medial arm of the incision is made just posterior to the medial edge of the tibia.…”

“…Luo et al [4,5] proposed a CT-based, threecolumn classification for tibial plateau, and the fractures can be categorized with a single column fracture (anterior, medial, or posterior column) or different types of combined column fractures (2 and 3 columns). Chang et al [6,7] classified the tibial articular plateau into four-quadrants, and the fractures are categorized with an isolated single quadrant (anteromedial, anterolateral, posteromedial, and posterolateral) and different combinations of 2, 3 and 4 quadrants. The fracture on each quadrant may have unique characteristics [8][9][10][11][12] as well as require related incision or treatment protocols [13,14].…”