title: Prone and direct posterior approach for management of posterior column tibial plateau fractures.
abstract: BACKGROUND
  The three-column fixation concept is becoming popular in orthopedic practice. Posterior column fracture is an uncommon type of tibial plateau fracture. The supine position for the surgical approach is familiar to most surgeons; however, it is difficult to achieve good reduction and fixation in posterior column fracture.
  
  
  OBJECTIVE
  The prone position and direct posterior approach can achieve proper reduction and fixation for posterior column tibial plateau fracture, yielding good functional outcome.
  
  
  METHODS
  Between January 2010 and January 2012, 184 tibial plateau fractures were diagnosed and operated on in our institution. Sixteen posterior column tibial plateau fractures (10 male and 6 female patients, with a mean age of 41.5 ± 14.3 years) were diagnosed by preoperative plain films and CT scans. Ten patients presented with fracture-dislocation of the knee joint. A direct posterior approach in prone position was used to reduce the tibial condyle and fix it with an anti-glide buttress plate. Radiographic evaluation included reduction quality and bone union. Functional evaluation included Lysholm score and Tegner activity score.
  
  
  RESULTS
  All fractures healed within 6 months, without secondary displacement. Ten knees had postoperative anatomic reduction (0mm step-off) and 6 had acceptable reduction (< 2mm step-off). At 34.4 ± 9.6 months, median extension was 3 (5-10) and flexion 135 (100-145). The mean Lysholm score was 95 (75-100) and the mean Tegner activity score was 6 (5-8). All patients were satisfied with the operation. No cases of post-traumatic osteoarthritis of the knee occurred during follow-up.
  
  
  CONCLUSIONS
  The prone position and direct posterior approach has great advantages in terms of reduction and stable fixation, yielding good results.
authors.affiliation: Department of Orthopaedics, Kaohsiung Veterans General Hospital, 813 Kaohsiung, Taiwan, ROC. Electronic address: kclin@isca.vghks.gov.tw.
authors.forename: K-C
authors.initials: KC
authors.lastname: Lin
authors.affiliation: Department of Orthopaedics, Kaohsiung Veterans General Hospital, 813 Kaohsiung, Taiwan, ROC.
authors.forename: Y-W
authors.initials: YW
authors.lastname: Tarng
authors.affiliation: Department of Orthopaedics, Kaohsiung Veterans General Hospital, 813 Kaohsiung, Taiwan, ROC.
authors.forename: G-Y
authors.initials: GY
authors.lastname: Lin
authors.affiliation: Department of Orthopaedics, Kaohsiung Veterans General Hospital, 813 Kaohsiung, Taiwan, ROC.
authors.forename: S-W
authors.initials: SW
authors.lastname: Yang
authors.affiliation: Department of Orthopaedics, Kaohsiung Veterans General Hospital, 813 Kaohsiung, Taiwan, ROC.
authors.forename: C-J
authors.initials: CJ
authors.lastname: Hsu
authors.affiliation: Department of Orthopaedics, Kaohsiung Veterans General Hospital, 813 Kaohsiung, Taiwan, ROC.
authors.forename: J-H
authors.initials: JH
authors.lastname: Renn
mesh_terms: D000328:Adult; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Posterior approach; Posterior column; Prone position; Proximal tibial fracture; Tibial plateau fracture