Treatment of posterior shearing tibial plateau fractures by modified posteromedial and posterolateral approaches

[Objective]A prospective study was designed to describe the patterns of posterior shearing tibial plateau fracture,and to evaluate the early results of surgical treatment by posteromedial or posterolateral approach.[Method]From August 2003 to July 2006,13 patients were identified as having posterior shearing tibial plateau fractures and treated with a L-shaped incision by a posteromedial or posterolateral approach made through the interval of semitendinosus,semimembranosus and the medial head of gastrocnemius or a posterolateral approach made through the gap of popliteus and soleus.A 3.5 mm LC-DCP plate was used as a buttress to support the postero-medial or posterolateral fragment which was visibly reduced.[Result]The average duration of follow-up was 14.5(range,13-16) months.All fractures healed after index surgery.The flexion of the knees achieved 105°(ranged from 80°-130°) at the first month postoperatively.It was improved to 115.3°(ranged from 90°-135°) at the 3rd month.One year later,the flexion of the knees achieved 125.1°(ranged from 115°-135°).There was no significant difference between tibial plateau angle(TPA) and posterior slope angle(PA) immediately,3 months and one year after operation(P0.05).According to the HSS system,the mean score was 92.1(ranged from 76-97) one year after operation.No complication occurred,such as deep infection,necrosis of skin incision or loosening and breakage of internal fixators.[Conclusion]This modified posteromedial and posterolateral approaches could reduce the complications in incision successfully for the direct reduction and buttress fixation of articular fragments,as well as and soft tissue.