Abstract
High-energy fractures of the proximal tibia with extensive fragmentation of the posterolateral
(PL) quadrant of the tibial plateau are challenging to manage. Herein, we present
a review of the literature on the patterns and options of approach and fixation of
the PL fragment of the tibial plateau to optimize the treatment of this specific injury
pattern. We searched PubMed (1980–May 2020) to identify and summarize the most relevant
articles evaluating both the morphology and treatment recommendations, including the
choice of approach and fixation strategy, for the PL tibial plateau fracture. We found
PL fragment can present in several patterns as a pure split, split depression, contained
pure depression, and noncontained depression (rim crush), which are mostly determined
by the position of the knee and the force magnitude applied during the course of the
accident. Based on previous concepts described by Schatzker and Kfuri, we suggest
a simplified treatment algorithm highlighting the two concepts (buttressing and containment)
used for plating the PL tibial plateau fragments. Based on the available current evidence,
we propose an algorithm for these two morphological types of PL tibial plateau fracture.
Shear-type fractures need buttressing (the “rule of thumb”), whereas noncontained
peripheral rim-type fractures need peripheral repair and containment. Contained pure
depression fractures are not frequent and need percutaneous-assisted elevation and
subchondral rafting, either controlled by fluoroscopy or arthroscopically. It is believed
that such an approach would simplify their assessment and preoperative planning and
would assist the clinicians to appreciate and manage more consistently these complex
injuries.
Keywords
tibial plateau - tibial plateau fracture - posterolateral corner - treatment algorithm
- treatment strategy
