Peter Behrendt1,2,3, Markus T Berninger4, Grégoire Thürig4,5, Julius Dehoust6, Jan H Christensen7, Karl-Heinz Frosch4,6, Matthias Krause4, Maximilian J Hartel4,6. 1. Department of Trauma Surgery, Orthopedics and Sports Orthopedics, Asklepios St. Georg, Hamburg, Germany. peter.behrendt.kiel@gmail.com. 2. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. peter.behrendt.kiel@gmail.com. 3. Department of Anatomy, Christian-Albrechts-University, Kiel, Germany. peter.behrendt.kiel@gmail.com. 4. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 5. Department of Orthopedics and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland. 6. Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany. 7. Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Abstract
INTRODUCTION: The aim of this study was to compare the reduction quality of the anterolateral (AL) and modified posterolateral approach (PL) in lateral tibial plateau fractures involving the posterior column and central segments. METHODS: Matched pairs of pre-fractured cadaveric tibial plateau fractures were treated by either AL approach (supine position) or PL approach (prone position). Reduction was controlled by fluoroscopy and evaluated as satisfying or unacceptable. Afterwards, the reduction was examined by 3D scan. RESULTS: 10 specimens (3 pairs 41B3.1, 2 pairs 41C3.3) were evaluated. PL approach achieved significantly (p 0.00472) better fracture reduction results (0.4 ± 0.7 mm) of the posterior column compared to the AL group (2.1 ± 1.4 mm). Fracture steps involving the central area of the lateral plateau were insufficiently reduced after fluoroscopy using both approaches. CONCLUSION: Optimal reduction of displaced tibial plateau fractures involving the posterolateral column necessitates a posterior approach, which can be conducted in prone or lateral positioning. The anterolateral approach is indicated in fractures with minor displacement of the posterolateral rim but fracture extension in the latero-central segments. In these cases, an additional video-assisted reduction or extended approaches are helpful.
INTRODUCTION: The aim of this study was to compare the reduction quality of the anterolateral (AL) and modified posterolateral approach (PL) in lateral tibial plateau fractures involving the posterior column and central segments. METHODS: Matched pairs of pre-fractured cadaveric tibial plateau fractures were treated by either AL approach (supine position) or PL approach (prone position). Reduction was controlled by fluoroscopy and evaluated as satisfying or unacceptable. Afterwards, the reduction was examined by 3D scan. RESULTS: 10 specimens (3 pairs 41B3.1, 2 pairs 41C3.3) were evaluated. PL approach achieved significantly (p 0.00472) better fracture reduction results (0.4 ± 0.7 mm) of the posterior column compared to the AL group (2.1 ± 1.4 mm). Fracture steps involving the central area of the lateral plateau were insufficiently reduced after fluoroscopy using both approaches. CONCLUSION: Optimal reduction of displaced tibial plateau fractures involving the posterolateral column necessitates a posterior approach, which can be conducted in prone or lateral positioning. The anterolateral approach is indicated in fractures with minor displacement of the posterolateral rim but fracture extension in the latero-central segments. In these cases, an additional video-assisted reduction or extended approaches are helpful.
Authors: A Korthaus; M Krause; G Pagenstert; M Warncke; F Brembach; Karl-Heinz Frosch; J P Kolb Journal: Arch Orthop Trauma Surg Date: 2021-12-28 Impact factor: 3.067
Authors: Brad Meulenkamp; Ryan Martin; Nicholas M Desy; Paul Duffy; Rob Korley; Shannon Puloski; Richard Buckley Journal: J Orthop Trauma Date: 2017-03 Impact factor: 2.512
Authors: Matthias Krause; Achim Preiss; Gunnar Müller; Jürgen Madert; Kai Fehske; Mirjam V Neumann; Christoph Domnick; Michael Raschke; Norbert Südkamp; Karl-Heinz Frosch Journal: Injury Date: 2016-09-06 Impact factor: 2.586