Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach

Abstract

To summarize the surgical technique and clinical effects of the extended anterolateral approach for the treatment of Schatzker type II and Schatzker type V/VI involving the posterolateral column tibial plateau. From January 2015 through December 2018, 28 patients with tibial plateau fractures involving the posterolateral column were included in the study. Among them, 16 patients were Schatzker type II treated using an extended anterolateral approach with lateral tibial locking compression plate fixation. Twelve patients were Schatzker type V or VI treated using an extended anterolateral combined with a medial approach using lateral tibial locking compression plate plus medial locking compression plate fixation. All cases were followed up for 15 to 31 months, with an average follow-up of 22.5 ± 3.7 months. During the follow-up, the tibial plateau angle (TPA), lateral posterior angle (PA) and Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation; the Hospital for Special Knee Surgery score and the range of motion were used to evaluate knee function. Additionally, the Lachman and knee Valgus (Varus) stress tests were used to evaluate anteroposterior and lateral stability of the knee. All fractures healed. At the 12-month follow-up, the Schatzker type II group revealed a mean TPA of 86.38 ± 3.92°, a mean PA of 7.43 ± 2.68°, and a mean Rasmussen radiological score of 16.00 ± 2.06 points. The Schatzker type V/VI group showed a mean TPA of 84.91 ± 3.51°, a mean PA of 9.68 ± 4.01°, and a mean Rasmussen radiological score of 15.33 ± 2.99 points. During the 1-year follow-up, when the postoperative PA was re-measured, the TPA and Rasmussen score of the 2 groups did not change significantly ( P > .05). At the last follow-up, the Schatzker type II group showed a knee flexion angle of 110° to 135° and a mean HHS score of 88.37 ± 10.01 points. The Schatzker type V/VI group revealed a knee flexion angle of 100° to 130° and a mean HHS score of 82.17 ± 10.76 points. Additionally, up to the last follow-up, the Lachman and knee Valgus (Varus) stress test results of the 2 groups were negative. No complications were found. The extended anterolateral approach is a good choice to treat tibial plateau fractures involving the posterolateral column.

Case Series of Tibial Plateau Fracture Treated Using Illizarov External Fixator – Functional and Radiological Outcome

“…Our outcome of radiological assessment are comparable to other studies using IEF or internal implants (5,6). Mao et al reported there is no difference in the radiological score when assessment was done at 3 months and 12 months (13).…”

Comparative Analysis of Posterior Approach Versus Anterior Approach for Posterior Tibial Plateau Fractures

“…The included studies were conducted in the United States (2 studies, n = 44) 16,17 , China (17 studies, n = 413) 2,6,18-32 , India (3 studies, n = 85) 33-35 , Taiwan (5 studies, n = 162) 7,8,36-38 , South Korea (1 study, n = 18) 39 , and Turkey (1 study, n = 25) 40 . Fourteen studies used the anterior approach (10 open surgery, 4 arthroscopic surgery) 6-8,16,19,23,24,26,30,31,35,38-40 , 9 studies used the posterior approach 18,27-29,32-34,36,39 , and 11 studies used the anterior combined posterior approach 2,17,19-22,24,25,35,37,39 .…”

“…According to the ROBINS-1 assessment tool 41 , 5 studies 16,23,25,26,40 were with a moderate risk of bias, 11 studies 6,17,19,24,27,28,30,31,36,37,39 were rated with a serious risk of bias, and 13 studies 2,7,8,18,20-22,29,32-35,38 were rated with a critical risk of bias (Appendices 1 and 2; http://links.lww.com/JBJSREV/A970). Twelve studies did not report the underlying diseases of the patients, which raises some concerns about adjusting confounding factors 2,6-8,17-22,24,27-39 .…”

Outcomes of Anterior Lateral Approach and Gerdy\'s Tubercle Osteotomy for Tibial Plateau Fractures Involving the Posterior Lateral Condyle: A Retrospective Study of 20 Patients

“…By Chen HW et al and Mao W et al, an extended anterolateral approach has been created, showcasing outstanding visualization potential. Through this approach, the plate can be placed in a more posterior position [ 22 , 23 ]. Additionally, Giordano et al [ 24 ] proposed the “hoop plate” technique, involving the insertion of a horizontally preformed 1/3 tubular steel plate from the outer to inner sides through the posterior lateral surgical approach (Lobenhoffer approach) of fibular head osteotomy, providing support and embracing effects for fractures resulting from posterior lateral cortical rupture, displacement, and comminuted articular surfaces.…”