The posterolateral corner of tibial plateau: When and how to fix?

Introduction: The posterolateral tibial plateau fractures remain a challenge and usually a tough nut to crack even for experienced surgeons. The proximity of the neurovascular structures and difficulty owing to the presence of the fibular head demands surgical skills and expertise. The purpose of this study is to understand the technical difficulties such as difficult exposure, limitation of distal extension of approach, limited implant choices. Material and Methods: 14 consecutive cases of isolated posterior fractures of the posterolateral tibial plateau were operated with a modified posterolateral approach without exposing the CPN between September 2016 and September 2019. Articular reduction quality was assessed according to the intraoperative fluoroscopy and immediate postoperative radiographs. Patients were followed up at 2 weeks, 4 weeks, 2 months, 4 months and 6 months. International knee score was assessed online, at the end of 6 months. Results: All patients were followed up, with a mean period of 8 months (range 25–40 weeks). Bony union was achieved in all patients. The average range of motion arc was 126° (range 110°–135°) and the mean postoperative IKS was 94.2 (range 81–97) at 6 months follow-up. None of the patients sustained neurovascular complications. Conclusions: The modified posterolateral approach could help to expand the surgical options for optimal treatment of this kind of fracture, and plating of posterolateral tibial plateau fractures would result in restoration and maintenance of alignment. This approach demands precise knowledge of the anatomic structures of this region but the results are gratifying.