Treatment of posterolateral tibial plateau fractures with modified Frosch approach: a cadaveric study and case series

This study aimed to investigate the surgical techniques and the clinical efficacy of a modified Frosch approach in the treatment of posterolateral tibial plateau fractures. The standard Frosch approach was performed on 5 fresh-frozen cadavers. The mean bony surface area was measured upon adequate exposure of the proximal tibial cortex. Lateral proximal tibial plate and posterolateral T-plates were placed and the ease of the procedure was noted. In the study, 12 clinical cases of posterolateral tibial plateau fractures were treated via modified or standard Frosch approaches. The outcome was assessed over short to medium follow-up period. Cadaver studies allowed the inspection of the posterolateral joint surface of all specimens from the lateral side. The mean bony surface areas of the exposed lateral and posterolateral tibial plateau were (6.78 ± 1.13) cm2 and (3.59 ± 0.65) cm2, respectively. Lateral and posterolateral plates were implanted successfully. Lateral proximal tibial plates were fixed in 10 patients via a modified Frosch approach while posterolateral plates were fixed in 2 patients via a standard Frosch approach. Patients were followed up for 10 to 24 months (average: 15.7 months) and no complications were observed during this period. Based on the Rasmussen knee function score system, the results were recorded as excellent, good, and fair in 6, 4, and 2 patients, respectively. In conclusion, the modified Frosch approach has offers advantages of clear clarity in exposure, convenient for reduction and internal fixation of a fracture, and good positive clinical results over the normal approach.