Anatomical and clinical basis for a posterior surgical approach in fractures of the posterior parts of the lateral tibial condyle

Abstract

Introduction Conventional anterolateral surgical approach to the lateral tibial condyle has been well studied and proven safe. However, this approach does not provide adequate visualization for performing a good quality osteosynthesis in fractures located in the posterior segment of the lateral condyle. Purpose of the investigation was a rationale of plate implantation technique on the posterior surface of the lateral tibial condyle from the posterior approach with anatomical and clinical demonstration of its technical feasibility and safety. Materials and methods The study was conducted on 10 knee joints of six unfixed cadavers. We implanted a T-plate on the posterior surface of the lateral tibial condyle using a posterior surgical approach. After that soft tissues were dissected to explore the exact location and the distances between the plate and crucial anatomic structures of the region. Five patients underwent surgical treatment of tibial plateau fractures 41C3 type following AO/OTA classification or Schatzker classification type V using the described method. The patients were followed-up for nine months after surgery. Results were evaluated using the KSS and Lysholm scales. Results The study on cadavers showed safety and feasibility of the surgical technique developed. We did not encounter specific complications associated with posterior plate implantation. All fractures healed after nine months postsurgery. The functional outcomes according to KSS scale were excellent in four cases and good in one case; according to Lysholm scale, three were excellent, one good and one fair outcome. Discussion In spite of the simplicity of the conventional anterolateral approach, many investigators tend to use different modifications of posterior approaches for the posterior lateral tibial condyle fixation. This method provides better reduction and fixation using a buttress plate. Our investigation showed safety and feasibility of this technique for fixation of the posterior segment of the lateral tibial condyle. The technique proposed, if performed properly, provides safe and accurate osteosynthesis and prevents secondary displacements of fragments in the rehabilitative period.