Assistant of the Trauma Surgery Group of Santa Casa de São Paulo.
Fellow of Trauma Surgery Group of the Department of Orthopedics and Traumatology, Santa Casa de São Paulo.
Injury. 2023 Nov;54 Suppl 6:110620. doi: 10.1016/j.injury.2023.02.003. Epub 2023 Feb 8.
The best surgical exposure and fixation method for fractures affecting the posterolateral corner of the tibial plateau remain debatable. This study describes a surgical approach to treat lateral depressions of the posterolateral tibial plateau with or without rim involvement by osteotomy of the lateral femoral epicondyle associated with osteosynthesis with a one-third tubular horizontal belt plate to stabilize the fracture fragment.
We evaluated 13 patients with fractures of the tibial plateau affecting the posterolateral region. Assessments included the degree of the depression (in millimeters), quality of the reduction, complications, and function.
All fractures and osteotomies consolidated. The patients had a mean age of 48 years and were mostly men (n=8). Regarding the quality of the reduction, the mean reduction obtained was 15.8 mm, and 8 patients achieved anatomical reduction. The mean (± standard deviation) Knee Society Score was 92±13 (range 65-100), and the mean Function Score was 95±9.6 (range 70-100). The mean Lysholm Knee Score was 92±11.7 (range 66-100), and the mean International Knee Documentation Committee Score was 85±12.6 (range 63-100). All these scores reflect good results. None of the patients developed superficial or deep infection or presented healing disorders. Sensitive or motor complications of the fibular nerve were not observed.
In this series of patients with depression fractures of the posterolateral tibial plateau, a surgical approach through osteotomy of the lateral femoral epicondyle allowed direct reduction and stable osteosynthesis of the fractures without functional impairment.
对于影响胫骨平台后外侧角的骨折，最佳的手术暴露和固定方法仍存在争议。本研究描述了一种通过外侧股骨髁截骨术治疗外侧胫骨平台后外侧凹陷骨折的手术入路，伴或不伴边缘受累，并采用三分之一管状水平带钢板进行骨合成以稳定骨折碎片。
我们评估了 13 例影响后外侧胫骨平台区域的骨折患者。评估包括凹陷程度（以毫米计）、复位质量、并发症和功能。
所有骨折和截骨均愈合。患者平均年龄为 48 岁，大多数为男性（n=8）。关于复位质量，平均获得的复位为 15.8 毫米，8 例患者达到解剖复位。膝关节协会评分的平均（±标准差）为 92±13（范围 65-100），功能评分的平均为 95±9.6（范围 70-100）。Lysholm 膝关节评分的平均为 92±11.7（范围 66-100），国际膝关节文献委员会评分的平均为 85±12.6（范围 63-100）。所有这些评分都反映了良好的结果。没有患者发生浅表或深部感染或出现愈合障碍。没有观察到腓总神经的感觉或运动并发症。
在本系列后外侧胫骨平台凹陷性骨折患者中，通过外侧股骨髁截骨术的手术入路可直接复位和稳定固定骨折，而不会造成功能损伤。
