Prone and direct posterior approach for management of posterior column tibial plateau fractures

Lin, Kai-Cheng; Tarng, Yih-Wen; Lin, Gau-Tyan; Yang, Shan-Wei; Hsu, Chien-Jen; Renn, Jenn-Huei

doi:10.1016/j.otsr.2014.12.021

Cited by 37 publications

(34 citation statements)

References 19 publications

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“…Head, chest, and abdominal injuries, for example, are difficult to monitor while the patient is lying in the prone position. 17 To prevent a cervical spine injury, the head must be positioned carefully and monitored throughout the procedure. Local risks include wound dehiscence or necrosis, and flexion contracture due to scarring.…”

Section: Discussionmentioning

confidence: 99%

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Posterior Surgical Approach to the Knee

Faucett

Gannon

Chahla

et al. 2017

Arthroscopy Techniques

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Posterior knee approaches are reliable techniques to address the treatment of various pathologies of the posterior region of the knee, including Baker cyst excision, tibial plateau fracture fixation, posterior cruciate ligament avulsions and inlay reconstructions, femoral condyle cartilage procedures, posterior meniscal repair and loose body removal among others. Surgery in the posterior knee region can be challenging because of the presence of neurovascular structures including the tibial nerve, popliteal artery and vein, and common peroneal nerve; thus, it is less commonly performed. The purpose of this Technical Note is to describe the posteromedial approach to the knee, its anatomic considerations, and how to avoid complications related to the surgical approach.

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Section: Discussionmentioning

confidence: 99%

“…Local risks include wound dehiscence or necrosis, and flexion contracture due to scarring. 17 Table 3 summarizes the advantages and disadvantages of this approach.…”

Section: Discussionmentioning

confidence: 99%

Posterior Surgical Approach to the Knee

Faucett

Gannon

Chahla

et al. 2017

Arthroscopy Techniques

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“…The longest reported period of immobilization, in full extension or slight flexion, was 2 weeks. 9 Early mobilization is frequently used in postoperative protocols following fixation and likely contributes to current range of motion (ROM) results. Given the limited number of wound complications, there appears to be no significant adverse effects related to early, guarded ROM.…”

Section: Postoperative Protocolmentioning

confidence: 99%

“…These occurred due to skin necrosis, superficial wound infection, and poor wound healing requiring removal of hardware. [9][10][11] There were no reports of deep infection in any of the studies reviewed. Given the limited number of studies and few patients in each study, no clear association can be identified between wound complications and any particular ap-proach, fixation technique, postoperative protocol, or fracture classification.…”

mentioning

confidence: 99%

Outcome of Posterior Tibial Plateau Fixation

Jiwanlal

Jeray

2015

J Knee Surg

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Isolated posterior tibial plateau fractures are rare injuries that encompass a wide variety of fracture patterns. Based on the variation in fracture pattern, the surgical approach varies, with both anterior and posterior approaches described for surgical fixation. Postoperative protocol also varies among studies. The aim of this article is to summarize the outcomes related to posterior column tibial plateau fractures. The papers reviewed, primarily small retrospective case series, showed functional knee range of motion is preserved, a low incidence of wound complications, and patient outcome scores comparable to other reported lower extremity injury outcome scores.

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“…Historically, surgical tactics for tibial plateau fractures have emphasized anterior surgical approaches and techniques because supine patient positioning is most commonly performed to avoid potentially vulnerable posterior neurovascular structures. Lin et al [ 2 ] described prone position to treat posterior column tibial plateau fracture yielding * Corresponding author. E-mail address: orthokcl@gmail.com (K.-C. Lin).…”

Section: Introductionmentioning

confidence: 99%

A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury

Tarng

Lin

2019

Injury

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a b s t r a c tIntroduction: Updated three column fixation of tibial plateau fractures (TPFs) arouse the importance of posterior column articular reduction. Complex TPFs with posterolateral (PL) articular injury is difficult to manage. We presented a strategy of combined positions and approaches to treat these injuries. Surgical technique was described and outcome of these were reported. Materials and Methods: From 2014 Jan to 2016 Dec, there were 132 patients of TPFs treated in our institute. Preoperative evaluation included plain films and 2D/3D CT scan to evaluate the involvement of articular surface and associated columns. Inclusion criteria were three column TPFs with PL corner injury. We put patients in prone position first with reverse L incision to manage PL articular impaction and posteromedial (PM) fractures. Then we repositioned the patients in supine to treat anterolateral fixation. Postoperative radiographic analysis, physical examination findings, and patient reported outcome scores from the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire were recorded. Results: Patient demographic information was retrospectively reviewed with a mean follow-up time of 34.4 months (range 24-48 months). The average time to union was 5.2 months (range 4-8months). 13/16 (81%) of patients had satisfactory articular reduction by plain films (less than 2 mm articular step off). All patients demonstrated healed without secondary displacement or infection. All patients demonstrated satisfactory coronal (medial proximal tibia angle 84.68 degrees) and sagittal alignment (posterior proximal tibia angle 84.75 degrees). Condylar width averaged 3.93 mm. 3/16 (19%) of cases required posterolateral columnar plating in addition to posteromedial columnar plating. The knee range of motion averaged 115 degrees (ranged from 0 degrees of extension to140 degrees flexion). The average KOOS score was 83/100 (range 76-90). 3 patients in the series developed a surgical site superficial infection and resolved after debridement and oral antibiotics use. No patient eventually received total knee arthroplasty at the last follow up. Conclusions: Our strategy provides an effective method to treat three column tibial plateau fractures with PL articular injury.

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Prone and direct posterior approach for management of posterior column tibial plateau fractures

Abstract: The prone position and direct posterior approach has great advantages in terms of reduction and stable fixation, yielding good results.

Cited by 37 publications

References 19 publications

Posterior Surgical Approach to the Knee

Posterior Surgical Approach to the Knee

Outcome of Posterior Tibial Plateau Fixation

A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury

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