Technical TrickA New Posterolateral Approach Without Fibula Osteotomy for the Treatment of Tibial Plateau FracturesFrosch, Karl-Heinz MD*†; Balcarek, Peter MD†; Walde, Tim MD†; Stürmer, Klaus Michael MD†Author Information From the *Department of Trauma and Reconstructive Surgery, Asklepios Clinic St Georg, Hamburg, Germany; and †Department of Trauma Surgery, Plastic and Reconstructive Surgery, Georg-August-University of Goettingen, Germany. Accepted for publication April 29, 2010. No funds were received in support of this work. Reprints: Karl-Heinz Frosch, MD, Head of the Department of Trauma and Reconstructive Surgery, Asklepios Clinic St Georg, Hamburg, Lohmühlenstrasse 5, 20099 Hamburg, Germany (e-mail: [email protected]; www.unfallchirurgie-hamburg.com). Journal of Orthopaedic Trauma: August 2010 - Volume 24 - Issue 8 - p 515-520 doi: 10.1097/BOT.0b013e3181e5e17d Buy Metrics Abstract The selection of a surgical approach for the treatment of tibia plateau fractures is an important decision. Approximately 7% of all tibia plateau fractures affect the posterolateral corner. Displaced posterolateral tibia plateau fractures require anatomic articular reduction and buttress plate fixation on the posterior aspect. These aims are difficult to reach through a lateral or anterolateral approach. The standard posterolateral approach with fibula osteotomy and release of the posterolateral corner is a traumatic procedure, which includes the risk of fragment denudation. Isolated posterior approaches do not allow sufficient visual control of fracture reduction, especially if the fracture is complex. Therefore, the aim of this work was to present a surgical approach for posterolateral tibial plateau fractures that both protects the soft tissue and allows for good visual control of fracture reduction. The approach involves a lateral arthrotomy for visualizing the joint surface and a posterolateral approach for the fracture reduction and plate fixation, which are both achieved through one posterolateral skin incision. Using this approach, we achieved reduction of the articular surface and stable fixation in six of seven patients at the final follow-up visit. No complications and no loss of reduction were observed. Additionally, the new posterolateral approach permits direct visual exposure and facilitates the application of a buttress plate. Our approach does not require fibular osteotomy, and fragments of the posterolateral corner do not have to be detached from the soft tissue network. © 2010 Lippincott Williams & Wilkins, Inc.