Three working windows posterior midline approach for posterior column tibial plateau fractures

Isolated posterior column tibial plateau fractures with combined posteromedial and posterolateral compression are challenging because conventional posterior approaches limit instrument trajectories and reduction vectors for distinct posterior fragments.

Ten patients with isolated posterior column tibial plateau fractures accompanied by combined posteromedial and posterolateral compression were treated using a posterior midline skin incision organized into three working windows. The central window served as the foundational posterior corridor, with medial and lateral windows developed as functional extensions to facilitate region-specific reduction and fixation. Relevant clinical data and outcomes were retrospectively analyzed.

Postoperative radiographs of all 10 patients showed satisfactory joint reduction and alignment. Radiographic fracture union was achieved in all cases at a mean of 13.9 weeks, with a mean follow up of 11.8 months. At final follow up, mean knee flexion was 124.0°, and mean knee extension was -2.1°, and the mean Hospital for Special Surgery (HSS) knee score was 90.8 points. One patient developed a superficial wound infection that resolved with antibiotic treatment, and one patient experienced deep vein thrombosis that was successfully treated with anticoagulation therapy. No neurovascular injuries, deep infections, or fixation failures were observed during follow up.

A posterior midline approach organized into three working windows may provide a feasible option for selected isolated posterior column tibial plateau fractures with combined posteromedial and posterolateral compression, allowing region-specific posterior fixation through a single posterior skin incision.