Our Experience with Posterior Approach for Posterior Tibial Plateau Fractures

Author:

Gavrilovski Andreja1,Dimovska Aleksandra Gavrilovska2,Ilie Radmila Mila Mihajlova3,Gjorikj Magdalena Petrushevska1

Affiliation:

1. 1 University Clinic of Traumatology (TOARILUC) , Skopje , RN Macedonia

2. 2 University Clinic of Neurosurgery , Skopje , RN Macedonia

3. 3 University Clinic of Emergency Department (TOARILUC) , Skopje , RN Macedonia

Abstract

Abstract Introduction: Posterior tibial plateau fractures are a rare type of fractures. Most surgeons are accustomed to operate in the supine position, however, surgery in the posterior knee region and operating in prone position can be challenging because of the presence of neurovascular structures including the tibial nerve, popliteal artery and vein, common peroneal nerve and, also challenging to achieve effective reduction and fixation, thus, it is less commonly performed. Materials and methods: Between February and September 2022 four posterior tibial plateau fractures were diagnosed and operated in our clinic within a six months follow-up (2 female and 2 male with mean age of 48.5 years). All were diagnosed with X-rays and CT scans. All of the fractures were on the right leg. Posterior “S shape” approach in prone position was used to reduce the tibial condyle and fix it with a plate. In fracture patterns that include lateral plateau impressions, the posterior “S shape” approach may not be sufficient to perform open reduction and internal fixation of the lateral condyle, so an additional anterolateral approach was made and additional locking plate was placed. Radiographic evaluation included reduction quality and satisfactory alignment of the bone axis. Results: All fractures healed within 6 months, without secondary displacement. Throughout the follow-up period, there were no incidences of post-traumatic osteoarthritis of the knee. No patient complained of knee instability. Conclusion: The direct dorsal approach allowed for adequate open reduction and internal fixation, and early clinical results are promising. However, in fracture patterns that include lateral plateau impressions, the posterior “S shape” approach may not be sufficient to perform open reduction and internal fixation of the lateral condyle, so an additional anterolateral approach should be made and additional locking plate to be placed.

Publisher

Walter de Gruyter GmbH

Reference15 articles.

1. Bhattacharyya T, McCarty LP 3rd, Harris MB, Morrison SM, Wixted JJ, Vrahas MS, Smith RM. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma. 2005;19:305–310.

2. Maripuri SN, Rao P, Manoj-Thomas A, Mohanty K. The classification systems for tibial plateau fractures: how reliable are they? Injury. 2008;39:1216–1221.

3. Hong-Wei Chen, Chang-Qing Chen, and Xian-Hong Yi . Posterior tibial plateau fracture: a new treatment-oriented classification and surgical management. Int J Clin Exp Med. 2015; 8(1): 472–479.

4. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res. 1979:94–104.

5. https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-tibia

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