Surgical Approaches to Posterolateral Tibial Plateau Fractures

Tibial plateau fractures involving the posterolateral articular surface present a unique challenge to treating surgeons due to the complex anatomy of the region. The posterolateral corner complex and the proximity of the common peroneal nerve restrict both the exposure of the joint surface and the ability to distract across the joint using a varus force. Further, injury to the soft tissue envelope may prevent use of the optimal surgical incision. For these reasons, a thorough understanding of the anatomy and available approaches is essential when treating these fractures. Approach selection should be based on fracture pattern, the surrounding soft tissue envelope, and the patient's clinical conditions; concomitant injuries and overall health status must be accounted for. In this article, we highlight five surgical approaches that can be utilized to improve visualization and access to the posterolateral tibial plateau. These include three separate osteotomies performed through an anterolateral approach: lateral femoral epicondyle osteotomy, fibular head resection osteotomy, and a novel digastric fibular osteotomy. In addition, we will discuss a posterolateral approach and a direct posterior approach.