Anterior approach to the knee with osteotomy of the tibial tubercle for bicondylar tibial fractures.

Eight patients--six who had a bicondylar fracture of the tibia and two who had a complex fracture-dislocation--were treated by open reduction and internal fixation that was achieved through an anterior approach to the knee. The approach included elevation of the tibial tubercle, proximal retraction of the extensor mechanism (patellar tendon, retropatellar fat pad, and patella), and transection and detachment of the anterior horn of one or both menisci. The extent of the approach depended on the specific need for exposure. The quality of reduction was better and the rate of complications was lower, compared with conventional approaches. The main advantage of this approach is that the tibial plateau and the intercondylar notch are exposed clearly and completely; this is a prerequisite for the rapid reconstruction of the joint surface and, in some patients, for the reattachment or primary suture of the cruciate ligaments. I recommend the anterior approach with osteotomy of the tibial tubercle in the treatment of patients who have a severe displaced bicondylar fracture of the proximal end of the tibia.