Technical TrickPosteromedial Supine Approach for Reduction and Fixation of Medial and Bicondylar Tibial Plateau FracturesWeil, Yoram A MD; Gardner, Michael J MD; Boraiah, Seervathsa MD; Helfet, David L MD; Lorich, Dean G MDAuthor Information From the Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY. Accepted for publication January 14, 2008. Reprints: Yoram A. Weil, MD, Orthopaedic Trauma Service, Hadassah Hebrew University Hospital, POB 12000 Jerusalem 91120, Israel (e-mail: [email protected]). Journal of Orthopaedic Trauma: May 2008 - Volume 22 - Issue 5 - p 357-362 doi: 10.1097/BOT.0b013e318168c72e Buy Metrics Abstract Traditionally, both high- and low-energy tibial plateau fractures are classified on the basis of the anteroposterior (AP) plain radiograph. Several fracture types exist that are not included in currently used classification schemes, including posteromedial shear and coronal plane fractures. These fracture types can appear as isolated fracture lines or as a part of a bicondylar plateau fracture. The purpose of this study is to describe a posteromedial supine surgical approach and antiglide plating of the posteromedial fragment, either as a single approach for a unicondylar posteromedial fracture or in combination with a second lateral approach for bicondylar fractures. We have used this technique in 27 patients that had posteromedial shear fractures on preoperative computed tomography (CT) scans, in the setting of a Level I trauma center. Ten were isolated medial plateau fractures, and 17 had bicondylar fractures. Radiographic analysis was done for all patients, and clinical outcomes were available in 19 out of 27 patients through phone interviews and chart reviews. Mean follow-up was 3.5 years (range 1-12 years). Seventy-five percent of patients had anatomic or good reductions. The average Oxford knee score was 19.9 ± 5.4 (12-29). Average range of motion was 0 to 120 (0-90 to 0-130). The articular malreduction (>5-mm gap or step-off) rate was 4%, and there were no wound complications. Posteromedial shear fractures of the tibial plateau are not uncommon. This pattern is assessable using the preoperative CT scan. A supine posteromedial approach with antiglide plating provides a good clinical solution for these complex injuries. © 2008 Lippincott Williams & Wilkins, Inc.