Intra-articular tibial plateau fractures can present a surgical challenge due to complex injury pat- terns and compromised soft tissue. The treatment goal is to spare the soft tissue and an anatomical reconstruction of the tibial articular surface. Depending on the course of the fracture, a fracture- speciﬁc access strategy is recommended to provide correct positioning of the plate osteosynthe- sis. While the anterolateral approach is used in the majority of lateral tibial plateau fractures, only one third of the joint surface is visible; however, posterolateral fragments require an individual approach, e. g. posterolateral or posteromedial. If necessary, osteotomy of the femoral epicondyles can improve joint access for reduction control. Injuries to the posterior columns should be ana- tomically reconstructed and biomechanically correctly addressed via posterior approaches. Bony posterior cruciate ligament tears can be reﬁxed via a minimally invasive posteromedial approach. Keywords Classiﬁcation · Minimally invasive surgery · Osteotomy · Patient positioning · Soft tissue injuries Der Unfallchirurg CME Abb. 1 9 Alternative Zugangswe- ge zur Darstellung der tibialen Ge- lenkﬂäche entsprechend der Zehn- segmentklassiﬁkation. Weiß antero- medialer Zugang ; rot posterio- ALL ALZ AZ AMZ AMM rer/posteromedialer Zugang [15, 19, 20]; gelbanterolateralerZugang; blau modiﬁzierter posterolateraler Zugang ; grün erweiterter
Der Unfallchirurg – Springer Journals
Published: Jun 6, 2018
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