title: Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures.
abstract: BACKGROUND
  The standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band (IT) and anterior tibialis origin in continuity from Gerdy's tubercle and metaphyseal flare. We describe an alternative approach to increase lateral plateau joint exposure and maintain iliotibial band insertion to Gerdy's tubercle.
  
  
  METHODS
  The approach entails a partial tenotomy of the anterior half of the IT band leaving the posterior IT band insertion attached to Gerdy's tubercle. Fracture lines around Gerdy's tubercle are completed or the tubercle was osteotomized and externally rotated and the joint overdistracted, allowing direct visualization of the joint depression. Joint elevation, grafting, and internal fixation are performed through this window.
  
  
  METHODS
  We retrospectively reviewed 76 patients (two groups), Schatzker Types I to II and IV to VI fractures (66 patients), between 1989 and 2005, and 10 patients, with 10 bicondylar posterior plateau fractures, from 2002 to 2010. All patients were followed a minimum of 12 months (average, 3.9 years; range, 12 months to 10 years). Ten patients, with posterior plateau fractures, received anterolateral plateau intraarticular osteotomy for exposure of centroposterior and posterolateral articular depression.
  
  
  RESULTS
  Average knee ROM was 2° of flexion (range, -3° to 5°) to greater than 120° of flexion (range, 100°-145°). In 66 patients, average articular depression improved from 7.4 mm to 1 mm (range, 0-5 mm) and, in 10 posterior fractures, from 18 mm to 1 mm (range, 0-4.5 mm). Infection occurred in one of the 76 patients; acute débridement and intravenous antibiotics resulted in control of the infection.
  
  
  CONCLUSIONS
  This approach reliably increases direct visualization of the lateral plateau articular fractures and maintains IT band insertion. Articular osteotomy of the anterolateral plateau provides access to extensive posterior plateau fractures.
authors.affiliation: Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California Los Angeles, CHS 76-116, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA. ejohnson@mednet.ucla.edu
authors.forename: Eric E
authors.initials: EE
authors.lastname: Johnson
authors.forename: Stephen
authors.initials: S
authors.lastname: Timon
authors.forename: Chukwunenye
authors.initials: C
authors.lastname: Osuji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome