Cho Jae-Woo, Kim Jinil, Cho Won-Tae, Kim Jin-Kak, Samal Puspak, Gujjar Pranay H, Kent William T, Oh Jong-Keon
Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-gu, Seoul, South Korea.
Int Orthop. 2017 Sep;41(9):1887-1897. doi: 10.1007/s00264-017-3563-6. Epub 2017 Jul 22.
To review available approaches and fixation methods for posterolateral fracture fragment (PLF) in tibial plateau fracture, and to propose an algorithm to treat various types of plateau fractures which all involve the PLF.
This article reviews multiple surgical approaches for PLF and suggests an algorithm for suitable approach and fixation method according to PLF with combined plateau fracture.
The modified anterolateral approach is a suitable single approach for fractures with a PLF combined with an anterolateral plateau fracture and for isolated posterolateral fracture fragments. For a multicolumn tibia plateau fracture involving the lateral, medial and posterior columns, dual approaches (modified anterolateral and posteromedial approach) can be used to access the entire plateau area.
When considering approaches of this complex fracture pattern, one must consider local soft tissue condition, plateau fracture morphology, associated injuries, and fixation options. After review of multiple approaches described in the literature for PLF fixation, we can suggest an algorithm for the approach and fixation to treat tibial plateau fractures with posterolateral fracture fragments.
回顾胫骨平台骨折中外侧后骨折块（PLF）的可用手术入路和固定方法，并提出一种算法来治疗所有涉及PLF的各类平台骨折。
本文回顾了PLF的多种手术入路，并根据合并平台骨折的PLF提出了合适的手术入路和固定方法的算法。
改良前外侧入路是治疗合并前外侧平台骨折的PLF骨折以及孤立的外侧后骨折块的合适单一入路。对于累及外侧、内侧和后侧柱的多柱胫骨平台骨折，可采用双入路（改良前外侧和后内侧入路）来显露整个平台区域。
在考虑这种复杂骨折类型的手术入路时，必须考虑局部软组织状况、平台骨折形态、合并损伤和固定选择。在回顾了文献中描述的PLF固定的多种手术入路后，我们可以提出一种治疗伴有外侧后骨折块的胫骨平台骨折的手术入路和固定算法。
