Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study

Orapiriyakul, Wich; Apivatthakakul, Theerachai; Phornphutkul, Chanakarn

doi:10.1007/s00402-018-2875-3

Cited by 21 publications

(21 citation statements)

References 32 publications

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“…Orapiriyakul et al compared the surgical exposure area between the Luo and the Yu (similar to the Carlson approach) approaches, and found the second to provide better exposure for buttressing the PL tibial plateau fracture. 28 For the reversed posteromedial approach, an approximately 10 cm L-shaped skin incision is made beginning at the center of the popliteal crease, curving distally at the medial corner of the popliteal fossa, and running along the posteromedial ridge of the tibial. 26 The medial head of the gastrocnemius muscle is retracted laterally protecting the popliteal neurovascular bundle.…”

Section: Surgical Techniques For Reconstruction Based On the Type Of mentioning

confidence: 99%

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

et al. 2020

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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.

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Section: Surgical Techniques For Reconstruction Based On the Type Of mentioning

confidence: 99%

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

et al. 2020

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“…Using variable angle -locking compression plates (VA-LCP) with a 30 degrees' cone allows us to diverge the VA-LCP locking (rafting) screws posteriorly through the fracture and ensure adequate fixation and articular support of extended lateral column fractures (Figure 1). Nevertheless, lateral ORIF does not always provide sufficient support of posterolateral (and posteromedial) column fractures (Figure 1) [11][12][13]. Surely enough, only 3/42 patients (7.1%) with a combined lateral and posterior column fracture were treated according to the TCC (i.e.…”

Section: Discussionmentioning

confidence: 99%

Limited value of the column concept in the operative management of posterior column tibial plateau fractures

Berg

Nijs

Hoekstra

2019

Eur J Trauma Emerg Surg

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Introduction: The three-column concept has been proposed as tool in surgical decision making for treating tibial plateau fractures. Recent studies have underscored the negative effect of posterior column tibial plateau fractures on clinical outcome. The purpose of this study was to assess the value of the three column concept and posterior plating in posterior column fractures. We hypothesized that treating patients according to the three-column concept improves functional outcome. Methods: 111 consecutive tibial plateau fractures, treated between January 2009 and December 2016, with at least a posterior column fracture were included. Relevant demographic and treatment variables were studied. Applied treatment was retrospectively evaluated according to the threecolumn concept. Patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Results: Median follow-up was 43.1 months (IQR 29.0-63.3) with a response rate of 80,2%. Outcomescores were markedly lower compared to the general population. 22.5% patients were treated according to the three-column concept and 27% was treated with posterior plating. Predominantly combined fractures of posterior and lateral columns were treated without fixation of the posterior column. Neither treatment according to the three-column concept and/or with posterior plating were found to significantly influence outcome. Conclusions: The outcome of posterior column fractures was equal, regardless of whether these fractures were treated or not. This indicates that the three-column concept seems insufficient and gives rise to further debate on surgical strategies of posterior column fractures. The implementation of trauma mechanism based fracture morphology in the threecolumn concept might be important in order to consummate the three-column concept as guiding tool.

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“…The common peroneal nerve was retracted gently to the lateral side and the lateral gastrocnemius was retracted to the medial side, so that the tension of retraction was mainly on the lateral gastrocnemius muscle and not the common peroneal nerve. This provides an adequate area for the fragments’ reduction and internal fixation by the buttress plate 13. Previous work in cadavers has demonstrated that, in isolated posterolateral tibial plateau fractures, it is possible to apply anatomical reduction and buttress plating on the posterior surface with a direct posterior split-gastrocnemius approach.…”

Section: Discussionmentioning

confidence: 99%

<p>Combined Direct Posterior Split-Gastrocnemius Approach for the Posterolateral Tibial Plateau Involved Fractures</p>

Chen¹,

Huang²,

Zheng³

et al. 2019

TCRM

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BackgroundSeveral approaches of fracture reduction and fixation are employed in complex tibial plateau fractures. However, there is a lack of consensus regarding reduction and fixation for fractures to the posterolateral part of the tibial plateau.HypothesisThe combined direct posterior split-gastrocnemius approach may be a choice of the posterior part involved comminuted tibial plateau fractures.Patients and methodsWe review cases of 216 patients with tibial plateau fracture and subsequent operation from 2012/1/1 to 2017/1/1. Fifty-six cases involved posterolateral plateau damage. For these 56 patients, we use anteromedial and direct posterior split-gastrocnemius approaches or anterolateral and direct posterior split-gastrocnemius approaches to fix the posterolateral and medial or lateral segments.ResultsFrom the radiography films, all patients (56/56) achieved a good reduction of the articular surface after surgery (31 patients were anatomic reduction, 25 patients were acceptable reduction). After 12 months follow up, only 2 patients showed poor reduction and no significant difference between <3 days after surgery and 12 months follow up. All patients acquired good knee functions at 12 months’ time-point of the fracture surgery. These patients have less pain and other related symptoms in daily living according to the Knee Injury and Osteoarthritis Scores.ConclusionThe direct posterior split-gastrocnemius approach provides efficient and less invasive access to the posterolateral tibial plateau, which is suitable for direct reduction and rigid fixation to the fragments of posterolateral tibial fractures. It is a valuable choice when mapping a surgical approach to tibial plateau fracture reduction involving the posterior tibial plateau and its implementation may offer better post-operative functionality relative to alternative approaches.

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Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study

Cited by 21 publications

References 32 publications

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

Limited value of the column concept in the operative management of posterior column tibial plateau fractures

<p>Combined Direct Posterior Split-Gastrocnemius Approach for the Posterolateral Tibial Plateau Involved Fractures</p>

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