Highlights
- •Joint congruity in tibial plateau fractures are fundamental, but a good posterior reduction is not achievable with standard approaches.
- •Frosch approach provides a good view of the back of the joint but is burdened by a large skin incision and not expose the lateral tibia.
- •Our modification of the Frosch approach provides an “S-shaped” incision that allows to better expose and control the CPN and the fracture.
Abstract
Achieving the best possible articular congruity following a tibial plateau (TP) fracture
is associated with better long-term functional outcomes; TP has an essential role
in the movements of the knee joint and is well established that a not optimal reduction
leads to articular instability and early osteoarthritis.
In recent times, 3D reconstruction from CT scan has greatly contributed to improve
the surgical treatment of these fractures since an accurate preoperative plan gives
the possibility to decide the best interventional strategy before the surgical incision.
Reduction of the posterior part of tibial plateau is not easily achievable with standard
surgical access.
Several posterolateral approaches, proposed by authors such as Frosch and Lobenhoffer,
have been described over the years; these approaches can be divided into 2 groups:
with or without osteotomy of the fibula.
Main disadvantages of these techniques are the large skin incision, the difficulty
of exposing the lateral face of the tibia, the high frequency of damages of the posterolateral
TP corner, and in some cases the necessity of performing fibular head osteotomy .
The surgical approach presented in this paper is a simple innovation of the well-known
Frosch approach: skin incision is about 12 centimeters in length and runs in a “S”
shape with the center positioned over the head of the fibula. It starts 2 centimeters
laterally to the tibial crest 6 centimeters below the tibial tuberosity and is directed
proximally, curving posteriorly at the level of fibular head and returning straight
in the most proximal part; it terminates 4 centimeters posteriorly the lateral femoral
condyle.
This innovative approach allows the trauma surgeon to achieve an optimal exposure
and control of posterior tibial plateau fractures, with the great advantage of being
able to treat the lateral tibial plateau with the same surgical incision.
Key words
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Article info
Publication history
Published online: March 17, 2021
Accepted:
March 14,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
☆This paper is part of a supplement supported by AOTrauma Italy.
Identification
Copyright
© 2021 Published by Elsevier Ltd.
