Posterolateral and anterolateral approaches to unicondylar posterolateral tibial plateau fractures: A comparative study

• Published in: Injury Vol. 44; no. 11; pp. 1561 - 1568
• Main Authors: Solomon, Lucian B, Stevenson, Aaron W, Lee, Yu C, Baird, Robert P.V, Howie, Donald W
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.11.2013
• Subjects: Adult; Aged; Female; Fracture fixation; Fracture Fixation, Internal - methods; Fracture Healing; Humans; Knee; Male; Menisci, Tibial - diagnostic imaging; Menisci, Tibial - surgery; Middle Aged; Orthopedics; Prospective Studies; Range of Motion, Articular; Surgical approach; Tibial fractures; Tibial Fractures - diagnostic imaging; Tibial Fractures - surgery; Tibial Meniscus Injuries; Tomography, X-Ray Computed; Treatment Outcome; Urban Population; Knee; Tibial fractures; Fracture fixation; Surgical approach
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2013.04.024

Abstract Background Lateral tibial plateau fractures that are located posterolaterally are difficult to reduce through an anterolateral surgical approach because of the lack of direct visualisation of the fracture. This study compared the results of unicondylar posterolateral tibial plateau fractures in two patient cohorts: one treated through a posterolateral direct approach and the other through an anterolateral indirect approach. Patients and methods All nine patients admitted to our hospital, a tertiary care, urban, public hospital in Australia, from 2007 to 2010 with unicondylar posterolateral tibial plateau fractures were treated through a direct posterolateral transfibular approach and prospectively studied. All eight patients admitted from 2004 to 2007 with unicondylar posterolateral tibial plateau fractures were treated through an indirect anterolateral approach and retrospectively reviewed. Fracture reduction and maintenance of reduction were assessed radiographically over 2 years. Knee function was assessed clinically and using the Lysholm score. Results Fractures managed through a direct posterolateral transfibular approach were reduced with no measurable articular step on standard radiography and had no loss of reduction over time. By contrast, fractures treated through an indirect anterolateral approach had a median postoperative articular step of 5.5 mm (interquartile range = 4.5). These displacements worsened over time in six of the eight patients. At 2 years, patients treated through a direct approach had significantly better Lysholm scores than those treated through an indirect approach. Conclusion This study suggests that a direct posterolateral transfibular approach to unicondylar posterolateral tibial plateau fractures results in improved reduction, stabilisation and functional outcomes at early follow-up compared to an indirect anterolateral approach.