Treatment of posterolateral tibial plateau fractures through an extended anterolateral approach / 中国骨伤

ABSTRACT

<p><b>OBJECTIVE</b>To study the methods and therapeutic effects of posterolateral tibial plateau fractures with an extended anterolateral approach.</p><p><b>METHODS</b>From January 2011 to December 2013, 15 patients with posterolateral tibial plateau fractures were treated by extended anterolateral approach, including 9 males and 6 females, with an average age of (38.4±7.7) years old ranging from 23 to 70 years old. Seven patients were on the left knees and 8 patients were on the right knees. The injury causes included traffic accidents in 6 cases, falling from height in 7 cases, and falling down when walking in 2 cases. The time from injury to operation was 2 to 14 days (means 5.6 days).</p><p><b>RESULTS</b>All patients were followed up with an average of 19.7 months ranging from 12 to 30 months. All patients were followed with anteroposterior and lateral X ray and CT films, which showed anatomic reduction or near anatomic reduction. The follow up CT scan showed an anatomic reduction in 14 patients and step and gap measurement of 3 mm in 1 case. The average radiographic bony union time was 9.6 weeks (ranged from 8 to 14 weeks). There were no wound complications, nonunion, plate loosening or breakage, valgus knee deformity, or fracture redisplacement. No patients sustained neural or vascular injuries, with knee extension of (2.1±2.1)° and knee flexion of (120.6±18.9)° at the final follow up. The total Rasmussen score averaged (25.0±2.8) points, the result was excellent in 10 cases, good in 4 cases, fair in 1 case.</p><p><b>CONCLUSIONS</b>The extended anterolateral approach has the advantage of allowing visualization of the posterolateral tibial plateau fragments, therefore facilitating its reduction. The approach also ensures safe and adequate posterior placement of a lateral buttress plate because the plate can be placed more posteriorly than can occur through an anterolateral approach.</p>