Treatment of posterolateral depression fractures of tibial plateau with improved posterolateral ap-proach and 2.4 mm distal radius locking plate

Objective To report the clinical results of treating posterolateral depression fractures of tibial plateau with improved posterolateral approach and 2.4 mm distal radius locking plate. Methods In the period from November 2013 to December 2015, 11 posterolateral depression fractures of tibial plateau underwent surgical treatment. They were 7 men and 4 women, aged from 23 to 75 years (average, 35.9 years). Based on the CT three-column classification, all were simple depression fractures of the posterolateral column; based on the AO/OTA classification, all were type 41B-2.2.4. All the fractures were exposed and reduced via the posterolateral approach. Following bone graft, 2.4 mm distal radius locking plates were used to fix the fractures. The knee function was evaluated at the final follow-up using The Hospital for Special Surgery (HSS) score. Lachman tests were conducted. The articular surfaces and the posterior slope angles were assessed on the X-ray films. Results No nerve symptoms were noted postoperatively. All the in-cisions got primary healing. The patients obtained follow-ups of 6 to 18 months (average, 10.4 months). The fractures united after 8 to 12 weeks (average, 9 weeks). Anatomical reduction was shown on the postoperative X-ray films. The mean posterior slope angle of the lateral tibial plateau was 7.7° (range, from 5° to 9°) im-mediately after operation, which was 7.8° (range, from 5° to 10°) 6 months after operation. The mean HSS score was 92.5 (range, from 90 to 97) at the final follow-up. The mean knee flexion was 128° (range, from 120° to 140°) 6 months after operation. All the Lachman tests gave a negative result. No breakage of the implants occurred in this series. Conclusion Internal fixation can be done safely, reliably and effectively with improved posterolateral approach and 2.4 mm distal radius locking plates in the treatment of posterolateral depression fractures of tibial plateau via a modified posterolateral approach. Key words: Tibial fractures; Knee joint; Fracture fixation, internal; Bone plates