A modified posterolateral approach for the treatment of posterolateral coronal fractures of the tibial plateau

Objective To introduce a modified posterolateral approach for the treatment of posterolateral coronal fractures of the tibial plateau.Methods From February 2008 to April 2010,28 patients with the posterolateral coronal fracture of the tibial plateau were operated on.They were 20 males and 8females,with a mean age of 34.5 years (range,from 28 to 62 years).According to the AO classification,there were 12 cases of type 41 B3,9 of type 41 C1,and 7 of type 41 C3.The patients were treated with buttress plate fixation via a modified posterolateral approach.The knee functions were estimated with the Hospital for Special Surgery (HSS) score system at 3 months,6 months and 1 year postoperatively.Imaging data were compared immediately,6 and 12 months after operation respectively.Results The 28 patients were followed up for an average of 15.7 months (range,from 12 to 18 months).All patients obtained bony union.There were no significant differences regarding the mean HSS score among 3 months,6 months and 1 year postoperation (P ＞ 0.05).There were no significance differences regarding the tibial plateau angle and posterior slope angle on radiographies among immediate,6 and 12 months postoperation (P ＞ 0.05).No complications associated with the approach were observed and there was no infection or fixation failure either.Conclusion Because the modified posterolateral approach can provide direct visual exposure to protect ligamentous structures and the soft tissue around the posterolateral fragments,it can be effectively used to treat posterolateral coronal fractures of the tibial plateau. Key words: Knee joint;  Fracture;  Bone plates;  Posterolateral column;  Posterolateral approach