Review Question - QID 4569

Posterior tibial plateau fractures are typically sustained from an axial load with the knee in flexion, leading to a large posterior shearing force on the tibial plateau from the condyles. This most commonly leads to a posterior fracture fragment, with variable involvement of the posteromedial or posterolateral joint line. The shearing nature of this fracture leads to an unstable fracture pattern.

Bhattacharyya et al reviewed 13 patients who underwent fixation of posterior tibial plateau fractures and noted a consistent fracture pattern with a primary, inferiorly displaced posteromedial shear fracture. They reported excellent clinical outcomes at a mean of 20 months, with the quality of articular reduction being one factor that correlated with functional outcome scores.

Fakler et al. was the first English-language study to publish the surgical outcomes of posterior tibial plateau fractures using the Lobenhoffer approach. In their two case study, the authors suggest that the Lobenhoffer approach is less morbid to the soft-tissues in comparison to other commonly described posterior approaches.

Figures A, B, C, and D show a tibial plateau fracture with posterior shear involvement. Illustrations A and B are postoperative images showing the same fracture pattern after posterior buttress plating.

Incorrect Answers:
Answer 1: This fracture fragment is not adequately captured with a lateral based plate; the lateral cortex is also intact, which limits the indications for this plate.
Answer 3: The primary fracture fragment is posterior and not medial.
Answer 4: No fracture is seen laterally; posteromedial plating can be utilized, however.
Answer 5: No fracture fragment is seen posterolaterally.