Liu Chen-Dong, Hu Sun-Jun, Chang Shi-Min, Du Shou-Chao, Chu Yong-Qian, Qi Yi-Ming, Li Hao-Tao, Mao Wei
Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, Republic of China.
Int J Surg. 2025 Jan 1;111(1):1071-1082. doi: 10.1097/JS9.0000000000001955.
The posterolateral tibial plateau is crucial for maintaining knee stability during flexion, and fractures in this area often involve ligament and meniscus injuries, necessitating effective management. However, treating posterolateral tibial plateau fractures (PLF) poses significant challenges due to the complex anatomy. Therefore, this review aims to explore contemporary concepts of PLF, from identification to fixation, and proposes a comprehensive treatment strategy. In this article, the authors detail the injury mechanisms, fracture morphology, PLF classification systems, surgical approaches, and techniques for open reduction and internal fixation (ORIF) as well as arthroscopic-assisted internal fixation (ARIF). The findings indicate that PLF is typically caused by flexion-valgus forces, resulting in depression or split-depression patterns. For isolated PLF, the supra-fibular head approach is often preferable, whereas posterior approaches are more suitable for combined fractures. Additionally, innovative plates, particularly the horizontal belt plate, have shown satisfactory outcomes in treating PLF. Currently, the 'bicondylar four-quadrant' concept is widely used for assessing and managing the tibial plateau fractures involving PLF, forming the cornerstone of the comprehensive treatment strategy. Despite challenges in surgical exposure and implant placement, ORIF remains the mainstream treatment for PLF, benefiting significantly from the supra-fibular head approach and the horizontal belt plate. Furthermore, ARIF has proven effective by providing enhanced visualization and surgical precision in managing PLF, emerging as a promising technique.
胫骨平台后外侧对于维持膝关节屈曲时的稳定性至关重要，该区域骨折常伴有韧带和半月板损伤，因此需要进行有效治疗。然而，由于解剖结构复杂，治疗胫骨平台后外侧骨折（PLF）面临重大挑战。因此，本综述旨在探讨PLF从诊断到固定的现代概念，并提出全面的治疗策略。在本文中，作者详细阐述了损伤机制、骨折形态、PLF分类系统、手术入路以及切开复位内固定（ORIF）和关节镜辅助内固定（ARIF）技术。研究结果表明，PLF通常由屈曲外翻暴力所致，导致凹陷或劈裂凹陷型骨折。对于单纯PLF，经腓骨头上方入路通常较为可取，而后方入路更适合于合并骨折。此外，创新型钢板，尤其是水平带板，在治疗PLF方面已显示出令人满意的效果。目前，“双髁四象限”概念广泛应用于评估和处理涉及PLF的胫骨平台骨折，构成了综合治疗策略的基石。尽管手术显露和植入物放置存在挑战，但ORIF仍然是PLF的主流治疗方法，经腓骨头上方入路和水平带板使其受益匪浅。此外，ARIF通过在处理PLF时提供更好的可视化和手术精度已被证明是有效的，成为一种有前景的技术。
