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Posteromedial Technique for Management of Tricondylar Tibial Plateau Fractures

March 01, 2020

Contributors: Dylan Lowe, MD; Yuhang Sun, MD; Nirmal C Tejwani, MD, FAAOS

Keywords: ORIF

Background The tibial plateau is a major weight-bearing surface in the body. Tibial plateau fractures may lead to knee instability, malunion, and posttraumatic arthritis. The goal of surgical management is to preserve joint mobility, joint stability, articular surface congruence, and axial alignment. Several classification systems have been created to characterize tibial plateau fractures. In 1979, Schatzker described a classification system based on AP radiographs. Although this is the most well-known tibial plateau fracture classification system, it fails to incorporate posterior plateau fracture patterns. Surgical approaches and fixation methods vary depending on the fracture pattern, and debate currently exists with regard to single versus double incisions for the management of these complicated fracture patterns. This video demonstrates fixation of a Schatzker type V tibial plateau fracture with a large posterior shear fragment, which is achieved via a posteromedial approach and minimally invasive lateral percutaneous fixation. Purpose This video provides an overview of and demonstrates open reduction and internal fixation of a Schatzker type V tibial plateau fracture with a large posterior shear fragment in a patient with a previous intramedullary tibial nail via a posteromedial approach with limited lateral percutaneous fixation. Methods The anatomy, classification, diagnosis, and management of tibial plateau fractures involving both condyles and a large posterior shear fragment are reviewed. The video discusses surgical indications and considerations, including the approach and fixation. The case presentation of a 50-year-old man with an acute Schatzker type V plateau tibial fracture with a large posterior shear fragment and a history of a intramedullary tibial nail is presented. Open reduction and internal fixation was achieved via a posteromedial approach with limited lateral exposure. Results Anatomic articular reduction and stable fixation were achieved intraoperatively. Conclusion Various fracture patterns have been observed in patients with a tibial plateau fracture. In patients in whom multiple condyles are affected, care must be taken to manage each condyle and limit soft-tissue disruption. A posteromedial approach with a limited lateral percutaneous incision can be used to achieve adequate fixation in a patient with a Schatzker type V tibial plateau fracture with a large posterior shear fragment.