Extended approach to the lateral tibial plateau with central meniscal subluxation in fracture repair: feasibility and fi
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ORIGINAL ARTICLE
Extended approach to the lateral tibial plateau with central meniscal subluxation in fracture repair: feasibility and first clinical and radiographic results Alexander Korthaus1 · Tobias Malte Ballhause1 · Jan‑Philipp Kolb1 · Matthias Krause1 · Karl‑Heinz Frosch1,2 · Maximilian J. Hartel1,2 Received: 27 May 2020 / Accepted: 18 August 2020 © The Author(s) 2020
Abstract Purpose Anatomic reduction in tibial plateau fractures remains to be demanding. For further visualisation of and approach to the joint surface an extended lateral approach using a lateral femoral epicondyle osteotomy and subluxation of the lateral meniscus was recently described. First clinical and radiographic mid-term results of this technique are presented in this feasibility study. Method Ten complex tibial plateau fractures treated with extended lateral approach and lateral meniscal subluxation were prospectively analysed. Clinical and radiographic results were objectified according to the Rasmussen scores. Results After a median follow-up of 8.6 (IQR 4.3) months good to excellent clinical and radiographic results were noted. The clinical Rasmussen Score showed a median of 25 (IQR 2.8) and radiographic a median of 17 (IQR 2.0) points. Conclusion Good to excellent clinical and radiological scores were obtained after using an extended lateral approach with lateral femoral epicondyle osteotomy and central meniscus subluxation. No approach specific complications could be observed. Keywords Tibial plateau fracture · Meniscus subluxation · Extended approach · Articular surface · Open reduction internal fixation
Introduction Tibial plateau fractures are amongst the uncommon fracture types with a proportion of less than 1% of all bony injuries [1]. Surgical therapy remains to be demanding as in most of the fractures with joint affection, the exact anatomic reduction is paramount [2]. Gaps and steps of more than 2 mm and varus or valgus deviations of more than 5° are significantly Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00068-020-01467-1) contains supplementary material, which is available to authorized users. * Maximilian J. Hartel [email protected] 1
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
Department of Trauma, Orthopaedic Surgery and Sports Traumatology, BG Trauma Hospital Hamburg, Hamburg, Germany
2
associated with impaired outcome [3]. However, articular malreductions after tibial plateau fracture fixation may still remain in more than 70–89% of the cases [4, 5]. Key factors to successful anatomic reduction are the thorough preoperative planning, resulting in the selection of the appropriate surgical approach. Failure to obtain accurate fracture visualization during surgery will increase the risk of malreductions [4, 6]. With the standard anterolateral approach, only 1/3 of the lateral tibiaplateau can be exposed [7]. For improved visualization extended approaches are
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