Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau |
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| Institution: | 1. Department of the Locomotive Apparatus, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil;2. Department of Orthopedics and Traumatology, Miguel Couto Hospital, Rio de Janeiro, RJ, Brazil;3. Department of Orthopedics and Traumatology, Federal University of São Paulo, São Paulo, SP, Brazil;4. Department of Orthopedics and Traumatology, Fundación Santa Fe de Bogotá, Bogotá, CU, Colombia;5. Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA, United States;1. Royal Victoria Hospital, Belfast, United Kingdom;2. Fracture Outcomes and Research Department (FORD), Royal Victoria Hospital, Belfast, United Kingdom;1. Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK;2. Department of Orthopaedics, Glasgow Royal Infirmary, UK;1. National and Kapodistrian University of Athens, Medical School, MSc “Cardiopulmonary Resuscitation”, Athens, Greece;2. Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece;1. Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece;2. European University Cyprus, School of Medicine, Nicosia, Cyprus |
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| Abstract: | ObjectiveEvaluate complication rates and functional outcomes of fibular neck osteotomy for posterolateral tibial plateau fractures.DesignRetrospective case series.SettingUniversity hospital.PatientsFrom January 2013 to October 2014, 11 patients underwent transfibular approach for posterolateral fractures of the tibial plateau and were enrolled in the study. All patients who underwent transfibular approach were invited the return to the hospital for another clinical and imaging evaluation.InterventionTransfibular approach (fibular neck osteotomy) with open reduction and internal fixation for posterolateral fractures of the tibial plateau.Main outcome measurementsComplications exclusively related to the transfibular approach: peroneal nerve palsy; knee instability; loss of reduction; nonunion and malunion of fibular osteotomy; and functional outcomes related to knee function.ResultsTwo patients failed to follow-up and were excluded from the study. Of the 9 patients included in the study, no patients demonstrated evidence of a peroneal nerve palsy. One patient presented loss of fracture reduction and fixation of the fibular neck osteotomy, requiring revision screw fixation. There were no malunions of the fibular osteotomy. None of the patients demonstrated clinically detectable posterolateral instability of the knee following surgery. American Knee Society Score was good in 7 patients (77.8%), fair in 1 (11.1%), and poor in 1 (11.1%). American Knee Society Score/Function showed 80 points average (60–100, S.D:11).ConclusionThe transfibular approach for posterolateral fractures is safe and useful for visualizing posterolateral articular injury. The surgeon must gently protect the peroneal nerve during the entire procedure and fix the osteotomy with long screws to prevent loss of reduction.Level of evidenceTherapeutic level IV. |
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| Keywords: | Tibial plateau Transfibular osteotomy Fibular neck osteotomy Fractures of the tibial plateau Peroneal nerve palsy Knee fractures Tibial plateau fractures Plate fixation Fractures Nonunion |
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