title: The extended posterolateral approach for split depression lateral tibial plateau fractures extending into the posterior column: 2 years follow up results of a prospective study.
abstract: OBJECTIVE
  To prospectively study the outcome of surgically treated split depression lateral tibial plateau fractures extending into the posterior column using the extended posterolateral approach.
  
  
  METHODS
  Twenty-one patients with split depression lateral tibial plateau fractures (AO: 41-B3) with extension into the posterior column were treated with open reduction and internal fixation through an extended posterolateral approach with osteotomy of the fibular neck±Gerdy tubercle. Follow up radiographs was assessed for quality of articular reduction and limb axis. Functional assessment was performed at last follow up using the Tegner-Lysholm score. Complications pertaining to the surgical approach were recorded.
  
  
  RESULTS
  The approach was performed in 15 patients with a fibular neck osteotomy alone and 6 patients required a Gerdy's tubercle osteotomy also. All fractures and osteotomies had united. Anatomical articular reduction was achieved in 16 patients. Radiological limb alignment was restored in all patients except for a reversed posterior slope in 1 patient. Arthritic changes were seen in 3 patients. The mean Tegner-Lysholm score was 87.3 (range: 76-95) at last follow up. No specific complications related to the surgical approach like common peroneal nerve injury and lateral instability of the knee was encountered.
  
  
  CONCLUSIONS
  The extended posterolateral approach offers excellent exposure posterior to the fibular head to perform articular reduction and fixation achieving satisfactory radiological and functional results in split depression lateral tibial plateau fractures extending into the posterior column.
authors.affiliation: Parvathy Hospital, Chennai, India. Electronic address: gavaskar.ortho@gmail.com.
authors.forename: Ashok S
authors.initials: AS
authors.lastname: Gavaskar
authors.affiliation: MOSC Medical College Hospital, Cochin, India.
authors.forename: Hitesh
authors.initials: H
authors.lastname: Gopalan
authors.affiliation: Swaram Hospital, Chennai, India.
authors.forename: Naveen C
authors.initials: NC
authors.lastname: Tummala
authors.affiliation: Mehta Hospital, Chennai, India.
authors.forename: Parthasarathy
authors.initials: P
authors.lastname: Srinivasan
mesh_terms: D000328:Adult; D005260:Female; D005360:Fibula / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction / Q000379:methods; D010027:Osteotomy / Q000379:methods; D010543:Peroneal Nerve / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: AO: 41-B3 fractures; Lateral tibial plateau fractures; Posterior column; Posterolateral rim fractures