Complex bicondylar tibial plateau fractures with reversed tibial slope - Our experience with a fracture-specific correction strategy

BACKGROUND: Tibial plateau fractures are complex and may result in sub-optimal results despite a timely and excellent reduction. An important cause for this may be the inability to detect and correct sagittal malalignment consequent to a reversal of the posterior tibial slope. We describe here the surgical steps to restore posterior tibial slope in a series of our patients with tibial condyle fractures involving the posterior column fragment using a fixed-angle locking plate. METHODS: This was a prospective cohort study of 4 cases who had sustained closed, bicondylar tibial plateau fractures (AO/OTA 41-C3) involving the posterior column fragment and reversed sagittal slope. All patients were operated in a prone position through a posterior approach. The fixation was done with a fixed angle locking plate. RESULTS: The average time taken for fracture union was 12 (range 10–15) weeks. The posterior tibial slope was restored in all the four patients (mean posterior proximal tibial angle = 8.5°, mean medial proximal tibial angle = 88°). There were no procedure-related complications. All patients attained excellent Knee Society Score at one year follow up (mean score = 93). CONCLUSION: A posterior approach in the prone position gives direct access to the fracture apex which eases the fracture reduction and fixation to correct the sagittal malalignment in tibial condyle fractures involving the posterior column fragment. We propose this approach as an critical surgical technique which helps in improved outcomes of tibial condylar fractures.