Extended lateral column tibial plateau fractures. How do we do it?

Area of Science:

• Orthopedic Surgery
• Traumatology
• Skeletal Biomechanics

Background:

• Extended lateral column tibial plateau fractures pose significant surgical challenges.
• The revised three-column classification provides a framework for managing complex fractures.
• Optimal surgical management aims for anatomical reduction and stable fixation to restore function.

Purpose of the Study:

• To describe a step-by-step operative management protocol for extended lateral column tibial plateau fractures.
• To evaluate the reliability and outcomes of a specific surgical technique using a limited lateral approach and locking screws.
• To assess the efficacy of the revised three-column classification in guiding surgical treatment.

Main Methods:

• A cohort of patients with extended lateral column tibial plateau fractures was treated using a standardized surgical approach.
• The technique involved a limited lateral arthrotomy and tibia condyle osteotomy.
• Fixation was achieved with free subchondral 2.7 mm locking screws and subsequently diverging VA-LCP locking screws.

Main Results:

• The described technique demonstrated reliable direct reduction and stable fixation of the articular surface.
• The use of free subchondral and diverging VA-LCP locking screws enhanced structural properties.
• The single lateral approach (Lazy-S) facilitated direct visualization and fixation, yielding good radiological outcomes and fair functional results.

Conclusions:

• Operative management of extended lateral column tibial plateau fractures using a limited lateral approach and specific locking screw constructs is a reliable and straightforward technique.
• This method allows for direct reduction and stable fixation under direct vision.
• The approach provides good radiological and acceptable functional outcomes for these complex fractures.