Treatment of the Posterolateral Tibial Plateau Fractures using the Anterior Surgical Approach

Abstract

Background: Fracture of the posterolateral tibial plateau is relatively uncommon. While surgical treatment by the posterior approach is theoretically ideal, this approach is associated with numerous complications. We describe a series of fractures of the posterolateral tibial plateau treated by the anterior surgical approach.

Methods: Fifteen patients with posterolateral tibial plateau fractures were included in this study. All patients were treated operatively using the anterior approach. The quality of fracture reduction was evaluated and functional results were estimated by the Hospital for Special Surgery knee scoring system.

Results: The most common cause of fracture was a motor scooter accident (86%, 13 of 15 patients), which may have resulted in the protective front plate of the scooter hitting the knee in the flexion position, causing an axial compression and valgus force, resulting in the fracture of the posterolateral tibial plateau. The average knee motion after surgery was 0-124° of flexion and 14 out of 15 patients (93%) experienced satisfactory articular reduction. There were no postoperative neural or vascular injuries and no wound complications. The average Hospital for Special Surgery knee score was 92 (range, 74-98).

Conclusions: In our series, with careful preoperative planning, the anterior approach for the surgical treatment of posterolateral tibial plateau fractures had no complications and was associated with satisfactory outcomes.

Keywords: anterior approach; posterior aspect; tibial plateau fracture.

Figure 1

(A–C), Anteroposterior, lateral radiographs, and computed tomography scans of the right knee in a 43-year-old female showing the split-depression fracture of the posterolateral tibial plateau. (D, E), Radiographs showing the fracture reduction and implant position following surgery.