Management of Posterior Articular Depression in Tibial Plateau Fractures

Abstract

Fractures involving the posterior aspect of the tibial plateau are challenging fractures to treat. Articular depression in tibial plateau fractures is usually addressed by elevation of the fragment(s), filling the residual defect with bone graft or bone substitute, and “raft” support of the articular fracture reduction with screws through a medially and/or laterally based plate. Posterior tibial plateau articular depression presents unique challenges for obtaining and maintaining fracture reduction. To obtain the goals of anatomic reduction and stable fixation, a thorough understanding of the fracture, specific approaches, reduction techniques, and stabilization strategies is needed. This article reviews the most current strategies for treating tibial plateau fracture patients with posterior articular depression.

Keywords

posterior knee - tibial plateau fracture - articular fracture - articular depression

• References

• 1 Russell TA, Leighton RK ; Alpha-BSM Tibial Plateau Fracture Study Group. Comparison of autogenous bone graft and endothermic calcium phosphate cement for defect augmentation in tibial plateau fractures. A multicenter, prospective, randomized study. J Bone Joint Surg Am 2008; 90 (10) 2057-2061
• 2 Karunakar MA, Egol KA, Peindl R, Harrow ME, Bosse MJ, Kellam JF. Split depression tibial plateau fractures: a biomechanical study. J Orthop Trauma 2002; 16 (3) 172-177
• 3 Heiney JP, Kursa K, Schmidt AH, Stannard JP. Reduction and Stabilization of Depressed Articular Tibial Plateau Fractures: Comparison of Inflatable and Conventional Bone Tamps: Study of a Cadaver Model. J Bone Joint Surg Am 2014; 96 (15) 1273-1279
• 4 Zhai Q, Hu C, Xu Y, Wang D, Luo C. Morphologic study of posterior articular depression in Schatzker IV fractures. Orthopedics 2015; 38 (2) e124-e128
• 5 Sohn HS, Yoon YC, Cho JW, Cho WT, Oh CW, Oh JK. Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures. J Orthop Trauma 2015; 29 (2) 91-97
• 6 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 1979; (138) 94-104
• 7 Marsh JL, Slongo TF, Agel J , et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007; 21 (10, Suppl): S1-S133
• 8 Luo C-F, Sun H, Zhang B, Zeng B-F. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 2010; 24 (11) 683-692
• 9 Bhattacharyya T, McCarty III LP, Harris MB , et al. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma 2005; 19 (5) 305-310
• 10 Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma 2005; 19 (2) 73-78
• 11 Chen HW, Liu GD, Ou S, Zhao GS, Pan J, Wu LJ. Open reduction and internal fixation of posterolateral tibial plateau fractures through fibula osteotomy-free posterolateral approach. J Orthop Trauma 2014; 28 (9) 513-517
• 12 Solomon LB, Stevenson AW, Baird RPV, Pohl AP. Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationale. J Orthop Trauma 2010; 24 (8) 505-514
• 13 Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscheme H. [Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures]. Unfallchirurg 1997; 100 (12) 957-967
• 14 Galla M, Riemer C, Lobenhoffer P. [Direct posterior approach for the treatment of posteromedial tibial head fractures]. Oper Orthop Traumatol 2009; 21 (1) 51-64
• 15 Cole P, Levy B, Schatzker J, Watson JT. Tibial plateau fractures. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, Krettek C, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. 4th ed. Philadelphia, PA: Saunders; 2009
• 16 Broome B, Mauffrey C, Statton J, Voor M, Seligson D. Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius. J Orthop Traumatol 2012; 13 (2) 89-95
• 17 Hahnhaussen J, Hak DJ, Weckbach S, Heiney JP, Stahel PF. Percutaneous inflation osteoplasty for indirect reduction of depressed tibial plateau fractures. Orthopedics 2012; 35 (9) 768-772
• 18 Pizanis A, Garcia P, Pohlemann T, Burkhardt M. Balloon tibioplasty: a useful tool for reduction of tibial plateau depression fractures. J Orthop Trauma 2012; 26 (7) e88-e93
• 19 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 (7) e169-e175
• 20 Lobenhoffer P, Gerich T, Witte F, Tscherne H. Use of an injectable calcium phosphate bone cement in the treatment of tibial plateau fractures: a prospective study of twenty-six cases with twenty-month mean follow-up. J Orthop Trauma 2002; 16 (3) 143-149
• 21 Yetkinler DN, McClellan RT, Reindel ES, Carter D, Poser RD. Biomechanical comparison of conventional open reduction and internal fixation versus calcium phosphate cement fixation of a central depressed tibial plateau fracture. J Orthop Trauma 2001; 15 (3) 197-206
• 22 McDonald E, Chu T, Tufaga M , et al. Tibial plateau fracture repairs augmented with calcium phosphate cement have higher in situ fatigue strength than those with autograft. J Orthop Trauma 2011; 25 (2) 90-95