Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California Los Angeles, CHS 76-116, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
Clin Orthop Relat Res. 2013 Sep;471(9):2760-7. doi: 10.1007/s11999-013-2962-2.
The standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band (IT) and anterior tibialis origin in continuity from Gerdy's tubercle and metaphyseal flare. We describe an alternative approach to increase lateral plateau joint exposure and maintain iliotibial band insertion to Gerdy's tubercle.
The approach entails a partial tenotomy of the anterior half of the IT band leaving the posterior IT band insertion attached to Gerdy's tubercle. Fracture lines around Gerdy's tubercle are completed or the tubercle was osteotomized and externally rotated and the joint overdistracted, allowing direct visualization of the joint depression. Joint elevation, grafting, and internal fixation are performed through this window.
We retrospectively reviewed 76 patients (two groups), Schatzker Types I to II and IV to VI fractures (66 patients), between 1989 and 2005, and 10 patients, with 10 bicondylar posterior plateau fractures, from 2002 to 2010. All patients were followed a minimum of 12 months (average, 3.9 years; range, 12 months to 10 years). Ten patients, with posterior plateau fractures, received anterolateral plateau intraarticular osteotomy for exposure of centroposterior and posterolateral articular depression.
Average knee ROM was 2° of flexion (range, -3° to 5°) to greater than 120° of flexion (range, 100°-145°). In 66 patients, average articular depression improved from 7.4 mm to 1 mm (range, 0-5 mm) and, in 10 posterior fractures, from 18 mm to 1 mm (range, 0-4.5 mm). Infection occurred in one of the 76 patients; acute débridement and intravenous antibiotics resulted in control of the infection.
This approach reliably increases direct visualization of the lateral plateau articular fractures and maintains IT band insertion. Articular osteotomy of the anterolateral plateau provides access to extensive posterior plateau fractures.
外侧胫骨平台骨折的标准治疗方法包括抬高阔筋膜张肌（IT）和胫骨前肌起点，从 Gerdy 结节和干骺端骨突连续进行。我们描述了一种替代方法，可以增加外侧平台关节的暴露，并保持阔筋膜张肌插入到 Gerdy 结节。
该方法需要部分切开前半部分的阔筋膜张肌，使后半部分的阔筋膜张肌插入附着在 Gerdy 结节上。完成 Gerdy 结节周围的骨折线或对结节进行截骨并向外旋转，过度伸展关节，直接观察关节凹陷。通过这个窗口进行关节抬高、植骨和内固定。
我们回顾性分析了 1989 年至 2005 年期间的 76 例患者（两组），Schatzker Ⅰ至Ⅱ型和Ⅳ至Ⅵ型骨折（66 例），以及 2002 年至 2010 年期间的 10 例双髁后平台骨折患者。所有患者均随访至少 12 个月（平均 3.9 年；范围 12 个月至 10 年）。10 例后平台骨折患者接受前外侧平台关节内截骨术，以暴露中心后和后外侧关节凹陷。
平均膝关节 ROM 为 2°屈曲（范围-3°至 5°）至 120°以上屈曲（范围 100°-145°）。在 66 例患者中，平均关节凹陷从 7.4mm 改善到 1mm（范围 0-5mm），在 10 例后骨折中，从 18mm 改善到 1mm（范围 0-4.5mm）。76 例患者中有 1 例发生感染；急性清创和静脉内抗生素治疗控制了感染。
这种方法可靠地增加了外侧平台关节骨折的直接可视化，并保持了阔筋膜张肌的插入。前外侧平台的关节截骨术为广泛的后平台骨折提供了通路。
