title: The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures: A novel surgical technique.
abstract: OBJECTIVE
  The posterolateral (PL) tibial plateau quadrant is laterally covered by the fibular head and posteriorly covered by a mass of muscle ligament and important neurovascular structures. There are several limitations in exposing and fixing the PL tibial plateau fractures using a posterior approach. The aim of this study is to present a novel anterolateral supra-fibular-head approach for plating PL tibial plateau fractures.
  
  
  METHODS
  Five fresh and ten preserved knee specimens were dissected to measure the following parameters:1) the vertical distance from the apex of the fibular head to the lateral plateau surface, 2) the transverse distance between the PL platform and fibula collateral ligament (FCL), and 3) the tension of the FCL in different knee flexion positions. Clinically, isolated PL quadrant tibial plateau fractures were treated via an anterolateral supra-fibular-head approach and lateral rafting plate fixation. The outcome of the patients was assessed after a short to medium follow-up period.
  
  
  RESULTS
  The distance from the apex of the fibular head to the lateral condylar surface was 12.2 ± 1.6 mm on average. With the knee extended and the FCL tensioned, the transverse distance between the PL platform and the FCL was 6.7 ± 1.1 mm. With the knee flexed to 60° and the FCL was in the most relaxed position, the distance increased to 21.1 ± 3.0 mm. Clinically, a series of 7 cases of PL tibial plateau fractures were treated via this anterolateral supra-fibular-head approach. The patient was placed in a lateral decubitus position with the knee flexed to approximately 60 degrees. After the posterior retraction of the FCL, the plate was placed more posteriorly to provide a raft or horizontal belt fixation of the PL tibial plateau fragment. After an average of 14.3 months of follow up, the knee range of motion(ROM) was 121.4° ± 8.8° (range: 105°-135°), the HSS score was 96.7 ± 2.6 (range: 90-100), and the SMFA dysfunction score was 22.4 ± 3.8 (range: 16-28) points.
  
  
  CONCLUSIONS
  The anterolateral supra-fibular-head approach can provide direct visualization of the posterolateral tibial plateau quadrant and put the plate more posteriorly to provide a raft for the fragments such that good clinical outcomes can be anticipated.
authors.affiliation: Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, People's Republic of China.
authors.forename: Sun-Jun
authors.initials: SJ
authors.lastname: Hu
authors.affiliation: Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, People's Republic of China. Electronic address: shiminchang11@aliyun.com.
authors.forename: Shi-Min
authors.initials: SM
authors.lastname: Chang
authors.affiliation: Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, People's Republic of China.
authors.forename: Ying-Qi
authors.initials: YQ
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, People's Republic of China.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, People's Republic of China.
authors.forename: Shou-Chao
authors.initials: SC
authors.lastname: Du
authors.affiliation: Department of Human Anatomy, Tongji University School of Medicine, 1239 Siping Road, Shanghai 200090, People's Republic of China.
authors.forename: Kai
authors.initials: K
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Horizontal belt plate; Lateral raft plate; Posterolateral fracture; Supra-fibular-head approach; Surgical approach; Tibial plateau fracture