Combined Direct Posterior Split-Gastrocnemius Approach for the Posterolateral Tibial Plateau Involved Fractures

BACKGROUND: Several approaches of fracture reduction and fixation are employed in complex tibial plateau fractures. However, there is a lack of consensus regarding reduction and fixation for fractures to the posterolateral part of the tibial plateau. HYPOTHESIS: The combined direct posterior split-gastrocnemius approach may be a choice of the posterior part involved comminuted tibial plateau fractures. PATIENTS AND METHODS: We review cases of 216 patients with tibial plateau fracture and subsequent operation from 2012/1/1 to 2017/1/1. Fifty-six cases involved posterolateral plateau damage. For these 56 patients, we use anteromedial and direct posterior split-gastrocnemius approaches or anterolateral and direct posterior split-gastrocnemius approaches to fix the posterolateral and medial or lateral segments. RESULTS: From the radiography films, all patients (56/56) achieved a good reduction of the articular surface after surgery (31 patients were anatomic reduction, 25 patients were acceptable reduction). After 12 months follow up, only 2 patients showed poor reduction and no significant difference between <3 days after surgery and 12 months follow up. All patients acquired good knee functions at 12 months’ time-point of the fracture surgery. These patients have less pain and other related symptoms in daily living according to the Knee Injury and Osteoarthritis Scores. CONCLUSION: The direct posterior split-gastrocnemius approach provides efficient and less invasive access to the posterolateral tibial plateau, which is suitable for direct reduction and rigid fixation to the fragments of posterolateral tibial fractures. It is a valuable choice when mapping a surgical approach to tibial plateau fracture reduction involving the posterior tibial plateau and its implementation may offer better post-operative functionality relative to alternative approaches.