Posteromedial Submeniscal Arthrotomy and Fixation with a Posteromedial Rim Plate in a Comminuted Medial Tibial Plateau Fracture

Abstract

Medial tibial plateau fractures generally present as simple metaphyseal fractures; however, certain cases may present as comminuted articular fractures. Medial and posteromedial anatomical plates have traditionally been used for their management; nevertheless, not all cases can be successfully managed using these implants. We present a comminuted posteromedial Schatzker type VI tibial plateau fracture case. Direct visualization and subsequent fixation using a posteromedial rim plate were achieved through a posteromedial approach and submeniscal arthrotomy. The adequate joint reduction and the obtained stability allowed satisfactory clinical and radiological outcomes. This variation of the classic posteromedial approach and the use of a posteromedial rim plate provide an alternative when facing comminuted medial tibial plateau fractures.

Importance of the Posterior Plate in Three‐Column Tibial Plateau Fractures: A Finite Element Analysis and Clinical Validation

“…Adequate buttressing strength and space can more effectively support the “bare area” of the posterior column. 34 Franulic et al 35 A recent cadaveric biomechanical study on bicondylar fractures highlighted that medial and lateral locking compression plates might delay full weight‐bearing due to insufficient strength when lacking support from bony union, especially in cases where the posterior column fracture is not addressed. 36 These findings partly explain why cases treated with the dual‐plate method in our study showed lower functional outcomes, likely due to inadequate posterior anatomical reduction and early rehabilitation.…”