Download PDF
J Knee Surg 2020; 33(10): 1010-1019
DOI: 10.1055/s-0039-1688918
Original Article

A Novel Method of the Treatment for Posterolateral Tibial Plateau Fractures

Dong Ren
1   Orthopaedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, China
,
Yueju Liu
1   Orthopaedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, China
,
Yanxi Chen
2   Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
,
Jian Lu
1   Orthopaedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, China
,
Zhaohui Song
1   Orthopaedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, China
,
Bing Zhou
3   Department of Orthopaedic Surgery, Gaoyou Hospital, Soochow University, Gaoyou, Jiangsu, China
,
Pengcheng Wang
1   Orthopaedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, China
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Reduction and fixation of posterolateral tibial plateau fracture via a posterolateral approach is challenging, and the posterolateral approach itself may injure the posterolateral ligament complex of the knee and can result in knee instability. We developed a new curved support plate (CSP) that can pass, via traditional anterolateral approach, through the superior tibiofibular interval and effectively support the posterolateral fragments. The purpose of our study was to determine the biomechanical reliability of the new plate and report the preliminary efficacy of the CSP for posterolateral tibial plateau fracture. In the biomechanical experiment, 40 synthetic tibias were used to create posterolateral shearing tibial fracture models, which were randomly assigned to groups A to D. Vertical displacement of the posterolateral fragments was measured under axial loads of 500 to 1,500 N. The new plate and 3.5-mm lateral locking plate exhibited similar control over fragment displacement. From June 2016 to August 2017, eight patients with posterolateral tibial plateau fracture underwent treatment with the CSP. Hospital for Special Surgery (HSS) knee score, knee flexion and extension ranges of motion, and complications were recorded to evaluate treatment effects. Eight patients (five men and three women, mean age 44 years [range, 23–66 years]) were enrolled in the study. Mean follow-up time was 13 months (range, 7–19 months). All patients achieved radiographic bone union by 3.3 months (range, 3–4 months) postoperatively. There were no complications of neurovascular injury, deep vein thrombosis, infection, and implant loosening throughout the follow-up period. At final follow-up, mean HSS score was 92.6 (88–96), with a mean knee flexion of 131.25 degrees (120–135 degrees) and a mean knee extension of 1 degree (0–5 degrees). Fixation of posterolateral tibial plateau fracture was easily and successfully achieved using our newly designed CSP, which may provide a new choice for posterolateral tibial plateau fractures.

Keywords

CSP - anterolateral approach - posterolateral tibial plateau fracture

Note

The study protocol was approved by the Ethics Committees of Third Hospital of Hebei Medical University (Approval #2016-005-1) and registered at the Chinese clinical trial center (#ChiCTR-OPC-16008719).




Publication History

Received: 07 May 2018

Accepted: 05 April 2019

Article published online:
24 May 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Cho JW, Samal P, Jeon YS, Oh CW, Oh JK. Rim plating of posterolateral fracture fragments (PLFs) through a modified anterolateral approach in tibial plateau fractures. J Orthop Trauma 2016; 30 (11) e362-e368
    CrossrefPubMedGoogle Scholar
  • 2 Stahel PF, Smith WR, Morgan SJ. Posteromedial fracture fragments of the tibial plateau: an unsolved problem?. J Orthop Trauma 2008; 22 (07) 504 –author reply 504–505
    CrossrefPubMedGoogle Scholar
  • 3 Hoekstra H, Rosseels W, Luo CF, Nijs S. A combined posterior reversed L-shaped and anterolateral approach for two column tibial plateau fractures in Caucasians: a technical note. Injury 2015; 46 (12) 2516-2519
    CrossrefPubMedGoogle Scholar
  • 4 Jiwanlal A, Jeray KJ. Outcome of posterior tibial plateau fixation. J Knee Surg 2016; 29 (01) 34-39
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Garner MR, Warner SJ, Lorich DG. Surgical approaches to posterolateral tibial plateau fractures. J Knee Surg 2016; 29 (01) 12-20
    PubMedGoogle Scholar
  • 6 Yu B, Han K, Zhan C, Zhang C, Ma H, Su J. Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee 2010; 17 (05) 313-318
    CrossrefPubMedGoogle Scholar
  • 7 Solomon LB, Stevenson AW, Baird RP, Pohl AP. Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationale. J Orthop Trauma 2010; 24 (08) 505-514
    CrossrefPubMedGoogle Scholar
  • 8 Sassoon AA, Torchia ME, Cross WW, Cass JR, Sems SA. Fibular shaft allograft support of posterior joint depression in tibial plateau fractures. J Orthop Trauma 2014; 28 (07) e169-e175
    CrossrefPubMedGoogle Scholar
  • 9 Biggi F, Di Fabio S, D'Antimo C, Trevisani S. Tibial plateau fractures: internal fixation with locking plates and the MIPO technique. Injury 2010; 41 (11) 1178-1182
    CrossrefPubMedGoogle Scholar
  • 10 Heidari N, Lidder S, Grechenig W, Tesch NP, Weinberg AM. The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau: a cadaver study. J Orthop Trauma 2013; 27 (04) 221-225
    CrossrefPubMedGoogle Scholar
  • 11 Kuwano T, Urabe K, Miura H. , et al. Importance of the lateral anatomic tibial slope as a guide to the tibial cut in total knee arthroplasty in Japanese patients. J Orthop Sci 2005; 10 (01) 42-47
    CrossrefPubMedGoogle Scholar
  • 12 Zhang W, Luo C-F, Putnis S, Sun H, Zeng ZM, Zeng BF. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee 2012; 19 (02) 94-98
    CrossrefPubMedGoogle Scholar
  • 13 Kim CW, Lee CR, An KC. , et al. Predictors of reduction loss in tibial plateau fracture surgery: focusing on posterior coronal fractures. Injury 2016; 47 (07) 1483-1487
    CrossrefPubMedGoogle Scholar
  • 14 Parkkinen M, Madanat R, Lindahl J, Mäkinen TJ. Risk factors for deep infection following plate fixation of proximal tibial fractures. J Bone Joint Surg Am 2016; 98 (15) 1292-1297
    CrossrefPubMedGoogle Scholar
  • 15 Hu SJ, Chang SM, Zhang YQ, Ma Z, Du SC, Zhang K. The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures: a novel surgical technique. Injury 2016; 47 (02) 502-507
    CrossrefPubMedGoogle Scholar
  • 16 Pires RES, Giordano V, Wajnsztejn A. , et al. Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau. Injury 2016; 47 (10) 2320-2325
    CrossrefPubMedGoogle Scholar
  • 17 Yoon YC, Sim JA, Kim DH, Lee BK. Combined lateral femoral epicondylar osteotomy and a submeniscal approach for the treatment of a tibial plateau fracture involving the posterolateral quadrant. Injury 2015; 46 (02) 422-426
    CrossrefPubMedGoogle Scholar
  • 18 Frosch KH, Balcarek P, Walde T, Stürmer KM. A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma 2010; 24 (08) 515-520
    CrossrefPubMedGoogle Scholar
  • 19 Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma 2005; 19 (02) 73-78
    CrossrefPubMedGoogle Scholar
  • 20 Gavaskar AS, Gopalan H, Tummala NC, Srinivasan P. The extended posterolateral approach for split depression lateral tibial plateau fractures extending into the posterior column: 2 years follow up results of a prospective study. Injury 2016; 47 (07) 1497-1500
    CrossrefPubMedGoogle Scholar
  • 21 Zhang P, Lian K, Luo D, Huang Z, Li T, Lin D. A combined approach for the treatment of lateral and posterolateral tibial plateau fractures. Injury 2016; 47 (10) 2326-2330
    CrossrefPubMedGoogle Scholar