Posteromedial plate application using medial midline incision for complex tibia plateau fractures: a retrospective study

BACKGROUND: Application of a posterior plate for tibia plateau fractures associated with posterior column involvement is becoming a widespread standard practice as previous studies have shown that additional fixation of the posterior column with a posteromedial buttress plate creates strongest fixation in terms of fracture stabilization This study evaluated the clinical and radiological results of patients undergoing surgery for complex tibial plateau fractures involving the posterior column with a posteromedial plate applied via a medial midline incision. METHODS: Medical records of patients undergoing surgery for Schatzker type IV, V, and VI tibia plateau fractures involving the posterior column in our institution were reviewed retrospectively. Patients with a follow-up of less than 1 year, pathological fractures, posterolateral column fractures requiring separate fixation, and open fractures were excluded from the study. Three-dimensional computed tomography (3D CT) was performed in all patients before surgery. The study population consisted of 25 patients (21 males and 4 females) with a mean age of 41.5 (19–66) years. The etiologies of the fractures were traffic accidents in seven cases, pedestrian falls in five cases, falls from a height in seven cases, and motor vehicle accidents in six cases. RESULTS: The mean follow-up period was 15.9 months (12–25), mean time to union was 14.32 (9–20) weeks, mean Knee Society score (KSS) was 88 (81–95), and range of movement (ROM) was 123° (95°–140°). Loss of reduction was detected in only one patient (4%). A superficial incisional infection occurred in an anterolateral incision in only one patient (4%), and it recovered after oral antibiotic therapy. None of the patients required early implant removal and none had vascular or nerve complications in the postoperative period. Postoperatively, 23 (92%) patients had anatomical reduction and 2 (8%) had acceptable reduction in the sagittal plane CT sections. Acceptable reduction was achieved in 6(24%) patients and anatomical reduction was achieved in 19 (76%) in the coronal plane CT sections (Table 2). CONCLUSIONS: Clinical results of posteromedial plate application using a single medial midline incision is promising as complication rates were very low and knee scores were high.