Intra-articular Osteotomies After Tibial Head Fractures

Abstract

Malreduced tibial plateau fractures often lead to pain and can be accompanied by instability, deviation of the mechanical axis, restricted mobility, and constant wear of the joint [1]. The main reasons for malreduction after tibial head fracture are insufficient visualization of the fractured joint surface or insufficient fixation with secondary loss of reduction [1]. It has been demonstrated, that through standard approaches only 30–40% of the joint surface can be visualized [2]. With standard approaches and intraoperative fluoroscopy around 30% of lateral tibial plateau fractures are not sufficiently reduced, especially in the posterolateral quadrant [3]. In bicondylar fractures the “posterolateral-central segment” is involved in 85% of all cases [4] and cannot be visualized by fluoroscopy [5] nor by a lateral standard approach [2]. Remaining steps of more than 5 mm in the posterolateral quadrant of the tibial head are associated with a worse clinical result [1, 6].