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European Journal of Orthopaedic Surgery & Traumatology

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19-11-2023 | Tibial Plateau Fracture | 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 | Issue 2/2024

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.

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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
Keyword: Tibial Plateau Fracture
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 2/2024
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-023-03755-z

At a glance: The STEP trials

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

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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