Tibial plateau fractures: a lot more to come!
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EDITORIAL
Tibial plateau fractures: a lot more to come! Michael J. Raschke1 · Elmar Herbst1
© Springer-Verlag GmbH Germany, part of Springer Nature 2020
In the last decade, therapeutic concepts in tibial plateau fractures have changed dramatically. This refers to the range of indications for operative treatment, pre- and postoperative evaluation, assessment and visualization, operative approach(es) as well as choice of implants. This is a result of an increasing scientific and clinical interest amongst trauma surgeons [2, 7]. When searching for tibial plateau fractures on PubMed, it becomes evident that the number of research items is continuously growing. Nevertheless, there are still some open questions that need to be addressed in the near future. Thus, the current issue of the European Journal of Trauma and Emergency Surgery focusses fully on this specific topic. About one third of tibial plateau fractures include a bicondylar, comminuted fracture pattern [5]. Surgical exposure, visualization and consequently reduction in such complex fractures is still challenging [9]. However, for the long-term results, an anatomic reduction is necessary to avoid accelerated progression of posttraumatic osteoarthritis [4, 14]. In contrast to this assumption, it is still not clear, how much of an intra-articular step-off can be tolerated in tibial plateau fractures [8]. Conflicting results due to a large heterogeneity in current literature make it difficult to draw any conclusions. In the current issue, the authors, therefore, focused on improving surgical exposure by optimizing the approaches to the tibial plateau. Fracture mal-reduction is often seen for posterolateral pathologies. In the article “The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed”, the authors describe an optimized stepwise extension of the conventional lateral approach to the tibial plateau and are providing a recipe for surgeons to avoid failure due to poor visualization [6]. Every trauma surgeon interested in tibial plateau fractures should be aware of these extended * Michael J. Raschke [email protected] 1
Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Albert‑Schweitzer‑Campus 1, 48149 Muenster, Germany
approaches described in detail in the current issue by Frosch et al. and Korthaus et al. [6, 10, 13]. Despite these conventional approaches, parts of the tibial plateau might not be properly seen intraoperatively. In such cases, fracturoscopy, arthroscopy and three-dimensional imaging might be helpful tools and should be available in every trauma center to obtain optimal postoperative results [3]. In a retrospective, multicenter cohort study from the Fracture Committee of the German Knee Society, 122 tibial plateau fractures have been followed clinically and radiographically for almost 3 years. In the current issue, it has been reported that in more than 95% clinical as well as radiological outcomes were good or even excellent [11]. Intere
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