Extended anterolateral approach for treatment of posterolateral tibial plateau fractures improves operative procedure and patient prognosis.

PURPOSE The treatment of posterolateral tibial plateau fracture remains controversial and challenging. Several approaches for this fracture have been applied for direct exposure and support plate fixation. However, several structures are to be at risk via posterior approach, which may affect exposure and plate application. To solve this problem, an extended anterolateral approach was developed and reported. METHODS 15 patients with posterolateral tibial plateau fractures treated with this approach were reviewed. The primary outcomes, such as Rasmussen functional score, and the secondary outcomes, such as knee deformity, postoperative infection, as well as complications were evaluated. RESULTS All 15 cases have been followed up for 12 to 30 months (19.7 months at average). Rasmussen functional score after surgeries was 25.0 ± 2.8 points. A score ≥ 27 points was considered as excellent (ten patients), a score of 20-26 points (four patients) was considered as good; and a score of 10-19 points (one patient) was considered as fair. Anatomic reductions were obtained in 14 patients, but a 3 mm gap was found in one patient. For all patients, there were no wound complications, nonunion, valgus knee deformities, plate loosening or breakages, or fracture re-displacements. No vascular or neural injuries occurred in any patient. CONCLUSION The extended anterolateral approach provides excellent visualization, which can facilitate the internal fixation and reduction of posterolateral tibial plateau fractures, and shows encouraging results.