Three-column subdivision for isolated posterolateral tibial plateau fractures and perspective surgical approaches

Background: This study aimed (1) to introduce a computed tomography (CT)-based classi-fication of the posterolateral compartment of the tibial plateau based on the fibula and to propose the individualized surgical approaches for each zone; and (2) to determine the sur-gical approach based on the classification, that would achieve a safe and effective reduction and could improve postoperative clinical outcomes. Methods: Eighteen cases of tibia plateau fracture involving the isolated posterolateral com-partment in a single institution were retrospectively analyzed. The posterolateral compart-ment of the tibial plateau was segmented into three zones based on the fibular position and an individualized surgical approach was proposed for each zone. In anterior Zone I, surgical treatment was performed using an extended anterolateral approach and the patient was placed in the supine position; in middle Zone II, using the transfibular approach in the supine position; in posterior Zone III, using the posteromedial approach in the prone posi-tion. Results: In all cases, anatomical articular reduction (intra-articular step off in CT images <2 mm) was achieved and maintained for the follow up period. The average mechanical medial proximal tibial angle was increased from 87.6 degrees before surgery to 88.2 degrees in the imme-diate postoperative period (P = 0.060), and maintained for the follow up period (mean 89.9 degrees at 1-year follow up). At the 1-year follow up, the knee range of motion averaged 140 degrees and the Lysholm knee function score was 95.0 points. Conclusion: An individualized surgical approach and fixation according to three-zone sub -division for isolated posterolateral tibial plateau fractures provided an effective and safe method to treat posterolateral tibial plateau fractures. (c) 2021 Elsevier B.V. All rights reserved.