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Direct approach is better for the treatment of posterolateral tibial plateau fractures
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Patients with posterolateral tibial plateau fractures whose lateral condyle fracture component was treated using a direct posterolateral approach showed superior results at 2-years follow-up than patients treated with an indirect anterolateral approach, according to a recently presented study.
“Posterolateral tibial plateau fractures treated through a posterolateral direct approach have better fracture reduction, stabilization and functional outcomes at early follow-up,” Lucian B. Solomon, MD, said during his presentation at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
Solomon and colleagues treated 17 patients with posterolateral tibial plateau fractures using an indirect anterolateral approach between 2004 and 2006 and managed the fractures of 18 patients using a direct posterolateral approach between 2007 and 2009. The study excluded one workers’ compensation case. Both groups had similar mechanisms of injury and gender distributions. The investigators found eight unicondylar and nine bicondylar fractures in both groups. Some of the bicondylar fractures required additional anteromedial approaches, Solomon said.
Patients who underwent anterolateral procedures were non-weightbearing for 6 weeks, while those in the posterolateral group were allowed immediate partial weightbearing. Outcome measures included complications, range of motion, stability, alignment, radiographic assessment, articular step, condylar widening and Lysholm scores.
Evaluations using standard radiographs at immediate postop and 2-year follow-up showed that patients who underwent a direct posterolateral approach had no measurable articular step and no loss of reduction over time, according to the study abstract.
Solomon and colleagues found that patients with Orthopaedic Trauma Association (OTA) type 41B3 fractures who underwent an anterolateral approached showed an average postoperative articular step of 4.25 mm, which increased to 7.4 mm during the study period. For OTA type 41C3 fractures in the anterolateral group, articular step started at an average of 4.6 mm and decreased to 5.3 mm.
For patients with 41B3 fractures, the Lysholm score was 91 in the posterolateral group vs. 79 in the anterolateral group. For patients with 41C3 fractures, the Lysholm score averaged 63 in the posterolateral group compared to 53 in the anterolateral group.
The investigators found four patients with residual restrictive range of motion and three patients with residual instability in the anterolateral group. Solomon noted that the posterolateral group showed a good range of motion and stability, and had no complications. – by Renee Blisard Buddle
Reference:
- Solomon LB, Stevenson A, Baird RP, et al. Posterolateral tibial plateau fractures have better results when treated through a direct approach. Paper #535. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
For more information:
- Lucian B. Solomon, MD, can be reached at the Department of Orthopaedics and Trauma, University of Adelaide Hospital, Level 4, Bace Building, RAH, North Terrace, Adelaide SA 5000, Australia, 66 8 8222 5661; email: bogdan.solomon@health.sa.gov.au.
- Disclosure: Solomon has no relevant financial disclosures.