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Low-energy fracture of posterolateral tibial plateau: Treatment by a posterolateral prone approach

Yu, Guang-Rong MD; Xia, Jiang PhD; Zhou, Jia-Qian MD; Yang, Yun-Feng PhD

Journal of Trauma and Acute Care Surgery: May 2012 - Volume 72 - Issue 5 - p 1416–1423
doi: 10.1097/TA.0b013e318248e7e5
Original Articles

BACKGROUND: Most of the posterolateral tibial plateau fractures are caused by low-energy injury. The posterior fracture fragment could not be exposed and reduced well through traditional approaches. The aim of this study was to review the results of surgical treatment of this kind of fracture using posterolateral approach with patient in prone position.

METHODS: The low-energy posterolateral fracture is defined as the main part of articular depression or split fragment limited within the posterior half of the lateral column. Direct reduction and buttress plate fixation through the posterolateral prone approach was applied in all the patients.

RESULTS: In our series, 15 of 132 (11.4%) patients with tibial plateau fractures were identified as low-energy posterolateral fractures. The clinical outcomes were available in 14 of the 15 patients through phone interviews and chart reviews. Mean follow-up was 35.1 months (range: 24–48 months). All the patients had anatomic or good reductions (≤2 mm step/gap). Average range of motion was 0.7 degrees to 123.2 degrees (5–110 degrees to 0–140 degrees). The complications were limited to one superficial wound infection, two slight flexion contractures, and five implants removal. The average modified hospital for special surgery knee score was 93.4 (range: 86–100).

CONCLUSIONS: The posterolateral prone approach provides excellent visualization, which can facilitate the reduction and posterior buttress plate fixation for low-energy posterolateral tibial plateau fractures and shows encouraging results.

LEVEL OF EVIDENCE: V, therapeutic study.

Shanghai, China

From the Department of Orthopedic Surgery, Tongji Hospital, Tongji University, Shanghai, China.

Submitted: June 13, 2011, Revised: December 20, 2011, Accepted: December 29, 2011.

Address for reprints: Guang-Rong Yu, MD, Department of Orthopedic Surgery, Tongji Hospital, Tongji University, 389 Xincun Road, Shanghai 200065, People's Republic of China; email: yuguangrong2002@163.com.

© 2012 Lippincott Williams & Wilkins, Inc.