The posterolateral approach for plating tibial plateau fractures: problems in secondary hardware removal.

摘要

Posterolateral tibial plateau fractures are recognized recently in orthopedic trauma. It can occur in isolation (only the posterolateral quadrant) or in combination (more than two quadrants) [ 1 ]. Although several papers have been published on this topic in the recent years, yet optimal and rational surgical approaches to various patterns has not been reached [2-7]. For isolated posterolateral tibial plateau fractures, we described a modified posterolateral approach without fibula neck osteotomy and reported 8 cases with excellent outcomes in 2009 [4]. With the patient lying in prone position, the fracture can be easily exposed through a lateral border dissection and medial retraction of the gastrocnemius and soleus muscles. After direct reduction under visualization, a small 3.5-mm T-plate placed in vertical direction over the posterolateral cortice buttresses the fracture very well.