ArticleJournal of orthopaedics2025
Bicondylar tibial plateau fracture dislocations with an intact anterolateral cortical Rim: Prevalence, fracture characteristics, and complications.
Article in Journal of orthopaedics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Bicondylar tibial plateau (BTP) fracture-dislocations with an intact anterolateral (AL) cortical rim present a unique treatment challenge due to posterolateral joint impaction. The purpose of this study was to determine the prevalence of this pattern within a large cohort of bicondylar tibial plateau fractures and describe fracture characteristics and complication rates. Methods: Patients undergoing open reduction and internal fixation of a BTP fracture at two Level 1 trauma centers between 2010 and 2023 were identified. Radiographs and CT scans were reviewed to identify medial fracture-dislocations with an intact anterolateral cortical rim. Posterior shearing injuries were excluded. Demographic, surgical, and outcome variables were collected. Results: In total, 46/455 patients (10 %) met inclusion criteria (average age 53 years, 52 % female, 71 % high-energy). The average posterolateral depression was 9 mm and 40 % of fractures had >50 % lateral plateau involvement. Twenty-seven (59 %) patients were treated with single medial plating and 9 (20 %) with dual medial plating. One (2.2 %) lateral meniscal tear was repaired. A single-incision approach was used in 34 cases (74 %), most commonly medial-only (63 %). Eight (17 %) patients required reoperation, including 2 (4.3 %) for deep infection. The post-operative medial proximal tibial and posterior proximal tibial angles were 88° (IQR: 86-89) and 9° (IQR: 7-11), respectively. The post-operative articular stepoff or gap was <5 mm for 89 % of cases. Conclusion: In this series, 1 in 10 bicondylar tibial plateau fracture-dislocations presented with an intact anterolateral cortical rim. The dominant surgical strategy of medial-only plating with low rates of meniscal repair in this series resulted in good restoration of condylar width and relatively low infection rates. Long-term studies are needed to determine the degree to which a separate lateral approach or lateral plating may influence functional outcomes, but a medial-only strategy can be utilized when soft tissue swelling precludes an additional lateral incision.
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