title: Can tibial plateau fractures be reduced and stabilised through an angiosome-sparing antero-lateral approach?
abstract: OBJECTIVE
  Tibial plateau fractures (TPFs) are an independent, non-modifiable risk factor for surgical site infections (SSIs). Current antero-lateral approaches to the knee dissect through the anterior tibial angiosome (ATA), which may contribute to a higher rate of SSIs. The aim of this study was to develop an angiosome-sparing antero-lateral approach to allow reduction and fixation of lateral TPFs and to investigate its feasibility in a consecutive cohort.
  
  
  METHODS
  Twenty cadaveric knees were dissected to define the position of the vessels supplying the ATA from the lateral tibial condyle to the skin perforators. Based on these results, an angiosome-sparing surgical approach to treat lateral TPFs was developed. Fifteen consecutive patients were subsequently treated through this approach. Clinical outcomes included assessment of SSI and Lysholm score. Fracture healing and stability were assessed using the Rasmussen score and radiostereometric analysis (RSA).
  
  
  RESULTS
  At the latest follow-up between 1 and 4 years, there was no report of SSI. Nine patients (60%) had good or excellent Lysholm scores. The mean Rasmussen score at final follow-up was 17 (median 18, range 14-18) with 10 patients (66%) graded as excellent. Fracture fragment migration measured using RSA was below 2mm in all cases.
  
  
  CONCLUSIONS
  This study has demonstrated that an angiosome-sparing antero-lateral approach to the lateral tibial plateau is feasible. Adequate stability of these fracture types was achieved by positioning a buttress plate away from the bone and superficial to the regional fascial layer as an 'internal-external fixator'.
  
  
  CONCLUSIONS
  The angiosome-sparing approach developed was able to be used in a prospective cohort and the clinical results to date are encouraging. Future clinical studies need to investigate the potential benefits of this surgical approach when compared with the previously described antero-lateral approaches.
authors.affiliation: Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia. Electronic address: bogdansolomon@mac.com.
authors.forename: Lucian B
authors.initials: LB
authors.lastname: Solomon
authors.affiliation: Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Christian Medical College, Vellore 632004, Tamil Nadu, India.
authors.forename: P R J V C
authors.initials: PR
authors.lastname: Boopalan
authors.affiliation: Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
authors.forename: Adhiraj
authors.initials: A
authors.lastname: Chakrabarty
authors.affiliation: Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Callary
mesh_terms: D000328:Adult; D001860:Bone Plates; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D006801:Humans; D007719:Knee Joint / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012039:Regional Blood Flow; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Angiosome; Internal fixation; RSA; Surgical site infection; Tibial plateau fracture