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DOI: 10.1055/s-0035-1570401
Posterior Column Tibial Plateau Fractures
Publication History
Publication Date:
31 December 2015 (online)
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Tibial plateau fractures occur commonly and most orthopedic surgeons are familiar with anterior-based surgical approaches to the proximal tibia. Posterior column tibial plateau fractures are less common and create unique challenges in exposure, reduction, and fixation of the articular surface. The posteromedial approach performed in the supine position for treatment of bicondylar tibial plateau fractures has been well described and is commonly performed. Fractures involving the posterolateral articular surface are rare and create unique operative challenges, as access is hindered by the fibula and peroneal nerve anteriorly and by the popliteal neurovascular structures posteriorly. In this issue of the Journal of Knee Surgery, I am pleased to present five articles written by experienced traumatologists that emphasize surgical approaches and tips and techniques for the management of posterior column injuries. The first three articles focus on surgical approaches. Kottmeier et al discuss the merits of a staged surgical approach starting with fixation in the prone position followed by a sequential posterior approach to address associated anterior articular injuries. Garner et al review the surgical approaches available to access the posterolateral articular surface and describe a novel digastric transfibular approach. Pierrie et al compare the exposure provided by the posteromedial and posterolateral approaches and make a case for the primary use of the posteromedial approach for accessing all posterior column fractures. The final two articles in this supplement discuss reduction techniques and outcomes. Adams and Della Rocca describe techniques for the management of posterior articular depressions specifically focusing on methods to elevate joint depression. Jiwanlal and Jeray review the published literature on posterior column injuries noting the lack of consensus on treatment methods and summarizing the expected outcomes of treatment. Upon completion of reading this supplement, I believe that the reader will be well versed in the current management of this injury and hope that this edition will serve as a reference to surgeons encountering this unique and challenging fracture pattern.