Tibial plateau fractures and surgical approaches

The gain in knowledge on the importance of posterior coronal fracture fragments in tibial plateau fractures has led to a rethinking with respect to reduction and osteosynthesis techniques. Posterior approaches for these fractures supported by anatomically contoured plate systems have become firmly established and supplementary to the anterolateral approach necessary for most fractures. In addition to the associated possibility of being able to achieve a 360 degrees treatment of these complex fractures, the risk of the complications associated with the medial approach can be reduced by considering the blood supply to the skin via direct cutaneous blood vessels and the subsequent use of a direct posterior approach. The direct posterior approach requires prone positioning of the patient; however, it ensures removal of sufficient amounts of bone graft from the posterior iliac crest to augment even large voids. Posterolateral instabilities may also be addressed by aposterolateral approach without performing osteotomy of the fibula but mobilization of the fibular nerve and exploring the posterolateral corner by dissecting the popliteus and soleus muscles.