Top

European Journal of Orthopaedic Surgery & Traumatology

19-11-2023 | Original Article

The prone posteromedial approach to the knee revisited: a safe and effective strategy for posterior tibial plateau fractures

Authors: Luke Schwartz, Abhishek Ganta, Sanjit Konda, Steven Rivero, Kenneth Egol

Published in: European Journal of Orthopaedic Surgery & Traumatology

Abstract

Purpose

To compare outcomes of patients with posterior tibial plateau fractures who underwent repair indirectly with an anterior approach to those who underwent direct repair with a prone “Lobenhoffer” operative approach.

Methods

A total of 44 patients with a posterior column tibial plateau fracture that underwent repair were identified. Twenty-two patients with 22 tibial plateau fractures were fixed using a prone Lobenhoffer approach. They were compared to 22 patients treated with an indirect reduction using a supine approach for similar fracture patterns. Data collection at minimum 1 year included: patient-reported outcome scores (SMFA), patient-reported pain, knee range of motion, complications and need for reoperation. Radiographs were reviewed for knee alignment, residual depression and fracture healing.

Results

All demographics were similar between the groups except BMI, which was lower in the prone group (P < 0.05). Fracture type according to age, Schatzker and three-column classification was matched between cohorts. There was no difference in outcomes including: pain, radiographic knee alignment, residual articular depression, functional outcome (SMFA), complications and need for reoperations. Knee flexion at 1 year was greater in the prone group (127.8 vs. 115.8; P = 0.018). In addition, surgical time was less in the prone group (mean 73.7 min vs. 82.3 min; P = 0.015).

Conclusion

The Lobenhoffer approach with direct reduction of posterior fracture fragments for complex tibial plateau fractures is an excellent option for these injuries. It allowed for faster surgery with improved ultimate knee range of motion in posterior column tibial plateau fractures.

Available only for authorised users

Galla M, Riemer C, Lobenhoffer P (2009) Die Osteosynthese posteromedialer Tibiakopffrakturen über einen direkten dorsalen Zugang [Direct posterior approach for the treatment of posteromedial tibial head fractures]. Oper Orthop Traumatol 1:51–64. https://doi.org/10.1007/s00064-009-1605-y. ( German) CrossRef

Fakler JK, Ryzewicz M, Hartshorn C, Morgan SJ, Stahel PF, Smith WR (2007) Optimizing the management of Moore type I postero-medial split fracture dislocations of the tibial head: description of the Lobenhoffer approach. J Orthop Trauma 21(5):330–336. https://doi.org/10.1097/BOT.0b013e318055603c CrossRefPubMed

Shields CN, Eftekhary N, Egol KA (2020) Posteromedial approach to tibial plateau fracture nonunion. J Orthop Trauma 34(Suppl 2):S33–S34. https://doi.org/10.1097/BOT.0000000000001826 CrossRefPubMed

Zeltser DW, Leopold SS (2013) Classifications in brief: Schatzker classification of tibial plateau fractures. Clin Orthop Relat Res 471(2):371–374. https://doi.org/10.1007/s11999-012-2451-z CrossRefPubMed

Chen HW, Chen CQ, Yi XH (2015) Posterior tibial plateau fracture: a new treatment-oriented classification and surgical management. Int J Clin Exp Med 8(1):472–9 PubMedPubMedCentral

Luo CF, Sun H, Zhang B, Zeng BF (2010) Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 24(11):683–692. https://doi.org/10.1097/BOT.0b013e3181d436f3 CrossRefPubMed

Deemer AR, Jejurikar N, Konda S, Leucht P, Egol KA (2023) Approach variation affects outcomes after operative repair of lateral tibial plateau fractures. Eur J Orthop Surg Traumatol 33(5):1705–1711. https://doi.org/10.1007/s00590-022-03343-7 CrossRefPubMed

Barei DP, Agel J, Swiontkowski MF (2007) Current utilization, interpretation, and recommendations: the musculoskeletal function assessments (MFA/SMFA). J Orthop Trauma 21(10):738–42. https://doi.org/10.1097/BOT.0b013e31815bb30f CrossRefPubMed

Charalambous CP, Tryfonidis M, Alvi F, Moran M, Fang C, Samarji R, Hirst P (2007) Inter- and intra-observer variation of the Schatzker and AO/OTA classifications of tibial plateau fractures and a proposal of a new classification system. Ann R Coll Surg Engl 89(4):400-4. doi: https://doi.org/10.1308/003588407X187667. Erratum in: Ann R Coll Surg Engl 89(5):478. Samaraji, R [corrected to Samarji, R]

10.

Mohd YR, Solayar GN, Ahmad AR (2020) Postero-medial Tibial plateau (Moore’s type) fracture and the importance of computer tomography in diagnosis: a case report. Orthop J Sports Med 8:00044. https://doi.org/10.1177/2325967120S00044 CrossRef

11.

Haefeli M, Elfering A (2006) Pain assessment. Eur Spine J. https://doi.org/10.1007/s00586-005-1044-x CrossRefPubMed

12.

Hake ME, Goulet JA (2016) Open reduction and internal fixation of the posteromedial Tibial Plateau via the lobenhoffer approach. J Orthop Trauma 30(Suppl 2):S35–S36. https://doi.org/10.1097/BOT.0000000000000582 CrossRefPubMed

13.

Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscheme H (1997) Spezielle posteromediale und posterolaterale zugänge zur versorgung von tibiakopffrakturen [Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures]. Unfallchirurg 100(12):957–67. https://doi.org/10.1007/s001130050218. ( German) CrossRefPubMed

14.

Shuaishuai W, Minglei Z, Yue Y, Dapeng W, Tongtong Z, Huimin L (2023) Clinical application of the modified posterolateral approach for treating posterior tibial plateau fractures. Front Bioeng Biotechnol 17(11):1150541. https://doi.org/10.3389/fbioe.2023.1150541 CrossRef

15.

Arjona-Giménez C, Navarrete-Jiménez JD, Nieto-Rodríguez O (2013) Vía de Lobenhoffer para la estabilización de fracturas de la región posteromedial de la meseta tibial [Lobenhoffer approach to stabilize fractures of the posteromedial tibial plateau]. Acta Ortop Mex 27(6):380–4 ( Spanish) PubMed

16.

Sinha S, Singh M, Saraf SK, Rastogi A, Rai AK, Singh TB (2019) Fixation of posterior Tibial Plateau fracture with additional posterior plating improves early rehabilitation and patient satisfaction. Indian J Orthop 53(3):472–478. https://doi.org/10.4103/ortho.IJOrtho_295_18 CrossRefPubMedPubMedCentral

17.

Wang SQ, Gao YS, Wang JQ, Zhang CQ, Mei J, Rao ZT (2011) Surgical approach for high-energy posterior tibial plateau fractures. Indian J Orthop 45(2):125–131. https://doi.org/10.4103/0019-5413.77131 CrossRefPubMedPubMedCentral

18.

Frosch KH, Balcarek P, Walde T, Stürmer KM (2010) A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma 24(8):515–520. https://doi.org/10.1097/BOT.0b013e3181e5e17d CrossRefPubMed

19.

Söylemez MS, Cepni SK, Kemah B, Batar S (2022) Posteromedial plate application using medial midline incision for complex tibia plateau fractures: a retrospective study. BMC Musculoskelet Disord 23(1):129. https://doi.org/10.1186/s12891-022-05087-1 CrossRefPubMedPubMedCentral

20.

Lin KC, Tarng YW, Lin GY, Yang SW, Hsu CJ, Renn JH (2015) Prone and direct posterior approach for management of posterior column tibial plateau fractures. Orthop Traumatol Surg Res 101(4):477–482. https://doi.org/10.1016/j.otsr.2014.12.021 CrossRefPubMed

21.

Case LD, Ambrosius WT (2007) Power and sample size. Methods Mol Biol 404:377–408. https://doi.org/10.1007/978-1-59745-530-5_19 CrossRefPubMed

22.

Banerjee A, Chitnis UB, Jadhav SL, Bhawalkar JS, Chaudhury S (2009) Hypothesis testing, type I and type II errors. Ind Psychiatr J 18(2):127–131. https://doi.org/10.4103/0972-6748.62274 CrossRef

Title: The prone posteromedial approach to the knee revisited: a safe and effective strategy for posterior tibial plateau fractures
Authors: Luke Schwartz
Abhishek Ganta
Sanjit Konda
Steven Rivero
Kenneth Egol
Publication date: 19-11-2023
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-023-03755-z

Keynote Webinar | Spotlight on Diet and Diabetes

Springer Medicine

The prone posteromedial approach to the knee revisited: a safe and effective strategy for posterior tibial plateau fractures

Abstract

Purpose

Methods

Results

Conclusion

Keynote Webinar | Spotlight on Diet and Diabetes

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content