Approaching the posterolateral quadrant of the tibial plateau: challenges and strategies

Fractures of the posterolateral quadrant of the tibial plateau result from axial load combined with valgus and knee flexion. They can occur in isolation or in combination with other plateau fracture patterns and be associated with lateral meniscus and anterior cruciate ligament injuries. Significant joint depression and/or split displacement can cause joint incongruity and instability, which necessitates reduction and appropriate surgical fixation to restore function. Surgical approaches to the posterolateral plateau can be challenging due to the anatomical relationship with the posterior musculature, fibula head, neurovascular structures, and ligamentous structures, resulting in a relatively small footprint for fixation strategies. There are several options for surgical approach, each with different levels of complexity and abilities to expose, reduce, and stabilize this quadrant. This article will review the available surgical approaches, outline their strengths and weaknesses, provide technical details on how to perform each, and list the relative indications for selecting each approach.