Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN.
J Orthop Trauma. 2014 Jul;28(7):e169-75. doi: 10.1097/BOT.0000000000000020.
Posterior depression of the lateral articular surface of the tibial plateau can be difficult to elevate and support with morselized bone graft and internal fixation. Progressive collapse after open reduction and internal fixation has been described and can lead to failure in treatment. A standard anterolateral approach to the tibia may not allow direct reduction and stabilization of posterolateral joint depression given the anatomic barriers of the fibular collateral ligament and the proximal tibiofibular articulation. Posterolateral approaches to the tibial plateau have been described and may allow direct reduction of the articular depression. These approaches, however, require dissection close to the common peroneal nerve, and some approaches also require a proximal fibular osteotomy. The use of an intraosseous fibular shaft allograft as an adjunct to open reduction and internal fixation in select cases of depressed posterolateral tibial plateau fractures allows both reduction of the joint and stabilization of the articular segment through a single approach familiar to many orthopaedic surgeons.
胫骨平台外侧关节面后髁凹陷用骨碎片和内固定很难抬高和支撑。切开复位内固定后可出现进行性塌陷，导致治疗失败。标准的胫骨前外侧入路由于腓侧副韧带和胫骨近端胫腓关节的解剖学限制，可能无法直接复位和稳定后外侧关节凹陷。已经描述了胫骨平台后外侧入路，可能允许直接复位关节凹陷。然而，这些方法需要在靠近腓总神经的部位进行解剖，一些方法还需要进行腓骨近段截骨。在选择的胫骨平台后外侧塌陷骨折病例中，使用骨内腓骨干同种异体骨作为切开复位内固定的辅助手段，允许通过许多骨科医生熟悉的单一入路同时复位关节和稳定关节段。
