Lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating for simple posterolateral tibial plateau fracture

Objective To explore the clinical efficacy of lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating for simple posterolateral tibial plateau fractures. Methods From January 2014 to February 2017, 11 patients with simple posterolateral tibial plateau fracture were treated at Department of Orthopaedics, General Hospital of Middle Military Command of PLA. They were 8 males and 3 females, aged from 21 to 55 years (average 41.8 years). In all of them the supra-fibular-head approach was used for lateral osteotomy according to the size and orientation of the fracture block. After the fracture was reset, a full bone graft was implanted under direct visualization, followed by fixation of the posterolateral bone mass with a lateral locking plate which was placed as far as possible above the fibular head. The patients were encouraged 6 weeks after surgery to do knee functional exercise within 90°. The therapeutic efficacy was evaluated at the final follow-up according to the Rasmussen’s criteria for knee functions. Results The average operative time was 74 minutes (from 55 to 90 minutes); the average intraoperative blood loss was 70 mL (from 40 to 120 mL). All the patients were followed up for 12 to 35 months (average, 17.5 months). No neurovascular injury or incision infection was observed. Bony union was achieved in all patients after 10 to 15 weeks (average, 12.5 weeks). Follow-ups found no implant loosening/breakage, genu valgum, genu varum, fracture redisplacement, or knee instability. According to the Rasmussen’s function evaluation of the knee joint, 10 cases were rated as excellent and one as good. Conclusion Lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating is a preferred treatment for simple posterolateral tibial plateau fractures. Key words: Knee joint; Fracture fixation, internal; Osteotomy; Posterolateral tibial plateau fracture; Surgical approach