Fibular head osteotomy: A new approach for the treatment of lateral or posterolateral tibial plateau fractures

Abstract 

Background

A variety of surgical approaches have been employed previously for the open reduction and internal fixation of the fractures of lateral and posterolateral tibial plateau. However, the commonly used lateral approach does not provide adequate exposure and access to the posterolateral aspect of the lateral tibial plateau. We developed a new approach with osteotomy of fibular head to solve this problem and report its preliminary result.

Methods

Eighty-two patients with lateral or posterolateral tibial plateau fractures had been treated by this approach. According to the fractures, partial or full heads of the fibula were removed, and knee joint function, including stability of the knee, was evaluated by X-ray and physical examinations.

Results

All 82 cases were followed up for a mean of 3.2 y（2.0-5.6 y). In each case, the fractures were completely healed and knee joint function was restored. No infection or skin and bone necrosis were found. After one year following the operation, functional assessment of the knee joints by Rasmussen's functional grading system revealed a mean score of 27.9 (24-30). In addition, the radiological assessment by Rasmussen's anatomical grading system resulted in a mean score of 16.8 (14-18). Six patients experienced occasional pain or bad wither pain around knee joints, three of which had lateral-longitudinal instability of knee joint and three lost height of the tibial plateau.

Conclusions

The new approach provides excellent visualization, which can facilitate the reduction and internal fixation for lateral or posterolateral tibial plateau fractures, and shows encouraging results.

Keywords: Tibial plateau, Fractures, Fibular head, Osteotomy, Approach