Surgical Technique: Tscherne-Johnson Extensile Approach for Tibial Plateau Fractures

Abstract

BackgroundThe standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band (IT) and anterior tibialis origin in continuity from Gerdy’s tubercle and metaphyseal flare. We describe an alternative approach to increase lateral plateau joint exposure and maintain iliotibial band insertion to Gerdy’s tubercle.Description of TechniqueThe approach entails a partial tenotomy of the anterior half of the IT band leaving the posterior IT band insertion attached to Gerdy’s tubercle. Fracture lines around Gerdy’s tubercle are completed or the tubercle was osteotomized and externally rotated and the joint overdistracted, allowing direct visualization of the joint depression. Joint elevation, grafting, and internal fixation are performed through this window.MethodsWe retrospectively reviewed 76 patients (two groups), Schatzker Types I to II and IV to VI fractures (66 patients), between 1989 and 2005, and 10 patients, with 10 bicondylar posterior plateau fractures, from 2002 to 2010. All patients were followed a minimum of 12 months (average, 3.9 years; range, 12 months to 10 years). Ten patients, with posterior plateau fractures, received anterolateral plateau intraarticular osteotomy for exposure of centroposterior and posterolateral articular depression.ResultsAverage knee ROM was 2° of flexion (range, −3° to 5°) to greater than 120° of flexion (range, 100°–145°). In 66 patients, average articular depression improved from 7.4 mm to 1 mm (range, 0–5 mm) and, in 10 posterior fractures, from 18 mm to 1 mm (range, 0–4.5 mm). Infection occurred in one of the 76 patients; acute débridement and intravenous antibiotics resulted in control of the infection.ConclusionsThis approach reliably increases direct visualization of the lateral plateau articular fractures and maintains IT band insertion. Articular osteotomy of the anterolateral plateau provides access to extensive posterior plateau fractures.Level of EvidenceLevel IV, retrospective study. See Guidelines for Authors for a complete description of levels of evidence.

Tibial Plateau Fracture Characteristics

“…[1][2][3][4][5][6][7] Commonly used classifications for tibial plateau fractures include the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, 8 the Schatzker classification, 9 the Luo classification, 10 and the Hohl 11 classification. [1][2][3][4][5][6][7] Commonly used classifications for tibial plateau fractures include the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, 8 the Schatzker classification, 9 the Luo classification, 10 and the Hohl 11 classification.…”

Double-Incision Approach and Early Rehabilitation in a Complicated Bicondylar Tibial Plateau Fracture: A Case Report

“…In this case report, the patient with bicondylar tibial plateau fractures treated with dual plating via a two-incision technique resulted in satisfactory clinical and radiologic outcomes, with an acceptable complication risk rate. Yao et al [8] support that a single external locked plate can be used to stabilize both tibial condyles; conversely, other authors [9,10] suggest alternative approaches that can be used alone or in combination with a usual approach. The postoperative results of the present study showed that the bicondylar tibial plateau fracture with articular comminution and dual-incision osteosynthesis technique had a significant effect on functional outcomes: excellent knee function and a high patient satisfaction regarding quality of life improvement.…”

Partial proximal tibia fractures

“…Thus, a fibular osteotomy, 13,14 lateral femoral epicondylar osteotomy 15 or posterolateral approach may be necessary.…”