Extended medial and extended lateral approach for tibial plateau fractures,Erweiterter medialer und erweiterter lateraler Zugang bei Tibiakopffrakturen

OBJECTIVE: Complete visualization of the articular surface in comminuted uni- or bicondylar tibial plateau fractures as a prerequisite for anatomical reconstruction to reduce the risk of posttraumatic osteoarthritis.

INDICATIONS: Unicondylar lateral or medial as well as bicondylar intra-articular tibial plateau fractures with central and/or dorsal fracture lines; comminuted destruction of the medial or lateral tibial plateau with dislocation of >2 mm.

CONTRAINDICATIONS: Critical soft tissue in the approach area, femoral condylar fracture, intraligamentous ruptures of the medial or lateral ligaments or the posterolateral corner.

SURGICAL TECHNIQUE: Medial: via the medial or anteromedial approach; lateral: via the antero- or posterolateral approach for open reduction and internal fixation of the tibial plateau fracture. Sharp dissection down to the medial/lateral ligamentous accompanying structures with subsequent presentation of the medial/lateral femoral epicondyle. Medial: approximately 2 × 2 cm osteotomy of the medial femoral epicondyle. Lateral: osteotomy of an approximately 1 × 1 × 0.5 cm bone block of the lateral femoral epicondyle either with protection or including the popliteus tendon running ventrally in the sulcus popliteus. In this case, a violation of the articular condyle should be avoided.

POSTOPERATIVE MANAGEMENT: Early functional posttreatment with full mobilization and 10-20 kg partial load bearing on forearm crutches, fracture-dependent for 6-12 weeks.

RESULTS: Very good visualization of the comminuted articular surface with postoperatively anatomical reconstruction of complex fracture patterns without postoperative concomitant instabilities.