Kottmeier Stephen A, Watson J Tracy, Row Elliot, Jones Clifford B
Department of Orthopedics, State University SUNY Stony Brook, Health Sciences Center Stony Brook NY, Stony Brook, New York.
Department of Orthopaedic Surgery, St Louis University, St. Louis, Missouri.
J Knee Surg. 2016 Jan;29(1):2-11. doi: 10.1055/s-0035-1564728. Epub 2015 Oct 19.
A critical assessment of radiographic and clinical outcomes after complex articular fractures of the proximal tibia demonstrates several aspects worthy of reevaluation and potential modification. These include a refined understanding of fracture pathoanatomy, injury classification, operative exposure, surgical timing, and preferred fixation constructs in addition to implant design modifications. Evolving trends include increasing appreciation of the importance of the fracture morphology in the axial plane and the role that the fracture pattern has on the choice of surgical approach. This focused review will highlight the attributes and limitations of classification schemes (both conventional and contemporary) as well as the role that posterior surgical approaches performed in the prone position may offer in select clinical scenarios. The merits of staged fixation (prone followed by supine patient positioning), its technique, indications, and potential liabilities are described and case examples offered.
