Voie d’abord postérieure directe en décubitus ventral dans la chirurgie de la colonne postérieure des fractures du plateau tibial ☆

Abstract Introduction The three-column fixation concept is becoming popular in orthopedic practice. Posterior column fracture is an uncommon type of tibial plateau fracture. The supine position for the surgical approach is familiar to most surgeons; however, it is difficult to achieve good reduction and fixation in posterior column fracture. Hypotheses The prone position and direct posterior approach can achieve proper reduction and fixation for posterior column tibial plateau fracture, yielding good functional outcome. Materials and methods Between January 2010 and January 2012, 184 tibial plateau fractures were diagnosed and operated on in our institution. Sixteen posterior column tibial plateau fractures (10 male and 6 female patients, with a mean age of 41.5 ± 14.3 years) were diagnosed by preoperative plain films and CT scans. Ten patients presented with fracture dislocation of the knee joint. A direct posterior approach in prone position was used to reduce the tibial condyle and fix it with an anti-glide buttress plate. Radiographic evaluation included reduction quality and bone union. Functional evaluation included Lysholm score and Tegner activity score. Results All fractures healed within 6 months, without secondary displacement. Ten knees had postoperative anatomic reduction (0 mm step-off) and 6 had acceptable reduction ( Conclusions The prone position and direct posterior approach has great advantages in terms of reduction and stable fixation, yielding good results. Type of study Retrospective, case series. Level of evidence IV.