Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau

Robinson Esteves Santos Pires, Vincenzo Giordano, André Wajnsztejn, Egidio Oliveira Santana, Rodrigo Pesantez, Mark A Lee, Marco Antônio Percope de Andrade

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective Evaluate complication rates and functional outcomes of fibular neck osteotomy for posterolateral tibial plateau fractures. Design Retrospective case series. Setting University hospital. Patients From January 2013 to October 2014, 11 patients underwent transfibular approach for posterolateral fractures of the tibial plateau and were enrolled in the study. All patients who underwent transfibular approach were invited the return to the hospital for another clinical and imaging evaluation. Intervention Transfibular approach (fibular neck osteotomy) with open reduction and internal fixation for posterolateral fractures of the tibial plateau. Main outcome measurements Complications exclusively related to the transfibular approach: peroneal nerve palsy; knee instability; loss of reduction; nonunion and malunion of fibular osteotomy; and functional outcomes related to knee function. Results Two patients failed to follow-up and were excluded from the study. Of the 9 patients included in the study, no patients demonstrated evidence of a peroneal nerve palsy. One patient presented loss of fracture reduction and fixation of the fibular neck osteotomy, requiring revision screw fixation. There were no malunions of the fibular osteotomy. None of the patients demonstrated clinically detectable posterolateral instability of the knee following surgery. American Knee Society Score was good in 7 patients (77.8%), fair in 1 (11.1%), and poor in 1 (11.1%). American Knee Society Score/Function showed 80 points average (60–100, S.D:11). Conclusion The transfibular approach for posterolateral fractures is safe and useful for visualizing posterolateral articular injury. The surgeon must gently protect the peroneal nerve during the entire procedure and fix the osteotomy with long screws to prevent loss of reduction. Level of evidence Therapeutic level IV.

Original languageEnglish (US)
Pages (from-to)2320-2325
Number of pages6
JournalInjury
Volume47
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Tibial Fractures
Osteotomy
Peroneal Nerve
Knee
Fracture Fixation
Neck
Paralysis
Internal Fracture Fixation
Joints

Keywords

  • Fibular neck osteotomy
  • Fractures
  • Fractures of the tibial plateau
  • Knee fractures
  • Nonunion
  • Peroneal nerve palsy
  • Plate fixation
  • Tibial plateau
  • Tibial plateau fractures
  • Transfibular osteotomy

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Pires, R. E. S., Giordano, V., Wajnsztejn, A., Oliveira Santana, E., Pesantez, R., Lee, M. A., & de Andrade, M. A. P. (2016). Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau. Injury, 47(10), 2320-2325. https://doi.org/10.1016/j.injury.2016.07.010

Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau. / Pires, Robinson Esteves Santos; Giordano, Vincenzo; Wajnsztejn, André; Oliveira Santana, Egidio; Pesantez, Rodrigo; Lee, Mark A; de Andrade, Marco Antônio Percope.

In: Injury, Vol. 47, No. 10, 01.10.2016, p. 2320-2325.

Research output: Contribution to journalArticle

Pires, RES, Giordano, V, Wajnsztejn, A, Oliveira Santana, E, Pesantez, R, Lee, MA & de Andrade, MAP 2016, 'Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau', Injury, vol. 47, no. 10, pp. 2320-2325. https://doi.org/10.1016/j.injury.2016.07.010
Pires, Robinson Esteves Santos ; Giordano, Vincenzo ; Wajnsztejn, André ; Oliveira Santana, Egidio ; Pesantez, Rodrigo ; Lee, Mark A ; de Andrade, Marco Antônio Percope. / Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau. In: Injury. 2016 ; Vol. 47, No. 10. pp. 2320-2325.
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abstract = "Objective Evaluate complication rates and functional outcomes of fibular neck osteotomy for posterolateral tibial plateau fractures. Design Retrospective case series. Setting University hospital. Patients From January 2013 to October 2014, 11 patients underwent transfibular approach for posterolateral fractures of the tibial plateau and were enrolled in the study. All patients who underwent transfibular approach were invited the return to the hospital for another clinical and imaging evaluation. Intervention Transfibular approach (fibular neck osteotomy) with open reduction and internal fixation for posterolateral fractures of the tibial plateau. Main outcome measurements Complications exclusively related to the transfibular approach: peroneal nerve palsy; knee instability; loss of reduction; nonunion and malunion of fibular osteotomy; and functional outcomes related to knee function. Results Two patients failed to follow-up and were excluded from the study. Of the 9 patients included in the study, no patients demonstrated evidence of a peroneal nerve palsy. One patient presented loss of fracture reduction and fixation of the fibular neck osteotomy, requiring revision screw fixation. There were no malunions of the fibular osteotomy. None of the patients demonstrated clinically detectable posterolateral instability of the knee following surgery. American Knee Society Score was good in 7 patients (77.8{\%}), fair in 1 (11.1{\%}), and poor in 1 (11.1{\%}). American Knee Society Score/Function showed 80 points average (60–100, S.D:11). Conclusion The transfibular approach for posterolateral fractures is safe and useful for visualizing posterolateral articular injury. The surgeon must gently protect the peroneal nerve during the entire procedure and fix the osteotomy with long screws to prevent loss of reduction. Level of evidence Therapeutic level IV.",
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AU - Wajnsztejn, André

AU - Oliveira Santana, Egidio

AU - Pesantez, Rodrigo

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AU - de Andrade, Marco Antônio Percope

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N2 - Objective Evaluate complication rates and functional outcomes of fibular neck osteotomy for posterolateral tibial plateau fractures. Design Retrospective case series. Setting University hospital. Patients From January 2013 to October 2014, 11 patients underwent transfibular approach for posterolateral fractures of the tibial plateau and were enrolled in the study. All patients who underwent transfibular approach were invited the return to the hospital for another clinical and imaging evaluation. Intervention Transfibular approach (fibular neck osteotomy) with open reduction and internal fixation for posterolateral fractures of the tibial plateau. Main outcome measurements Complications exclusively related to the transfibular approach: peroneal nerve palsy; knee instability; loss of reduction; nonunion and malunion of fibular osteotomy; and functional outcomes related to knee function. Results Two patients failed to follow-up and were excluded from the study. Of the 9 patients included in the study, no patients demonstrated evidence of a peroneal nerve palsy. One patient presented loss of fracture reduction and fixation of the fibular neck osteotomy, requiring revision screw fixation. There were no malunions of the fibular osteotomy. None of the patients demonstrated clinically detectable posterolateral instability of the knee following surgery. American Knee Society Score was good in 7 patients (77.8%), fair in 1 (11.1%), and poor in 1 (11.1%). American Knee Society Score/Function showed 80 points average (60–100, S.D:11). Conclusion The transfibular approach for posterolateral fractures is safe and useful for visualizing posterolateral articular injury. The surgeon must gently protect the peroneal nerve during the entire procedure and fix the osteotomy with long screws to prevent loss of reduction. Level of evidence Therapeutic level IV.

AB - Objective Evaluate complication rates and functional outcomes of fibular neck osteotomy for posterolateral tibial plateau fractures. Design Retrospective case series. Setting University hospital. Patients From January 2013 to October 2014, 11 patients underwent transfibular approach for posterolateral fractures of the tibial plateau and were enrolled in the study. All patients who underwent transfibular approach were invited the return to the hospital for another clinical and imaging evaluation. Intervention Transfibular approach (fibular neck osteotomy) with open reduction and internal fixation for posterolateral fractures of the tibial plateau. Main outcome measurements Complications exclusively related to the transfibular approach: peroneal nerve palsy; knee instability; loss of reduction; nonunion and malunion of fibular osteotomy; and functional outcomes related to knee function. Results Two patients failed to follow-up and were excluded from the study. Of the 9 patients included in the study, no patients demonstrated evidence of a peroneal nerve palsy. One patient presented loss of fracture reduction and fixation of the fibular neck osteotomy, requiring revision screw fixation. There were no malunions of the fibular osteotomy. None of the patients demonstrated clinically detectable posterolateral instability of the knee following surgery. American Knee Society Score was good in 7 patients (77.8%), fair in 1 (11.1%), and poor in 1 (11.1%). American Knee Society Score/Function showed 80 points average (60–100, S.D:11). Conclusion The transfibular approach for posterolateral fractures is safe and useful for visualizing posterolateral articular injury. The surgeon must gently protect the peroneal nerve during the entire procedure and fix the osteotomy with long screws to prevent loss of reduction. Level of evidence Therapeutic level IV.

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KW - Knee fractures

KW - Nonunion

KW - Peroneal nerve palsy

KW - Plate fixation

KW - Tibial plateau

KW - Tibial plateau fractures

KW - Transfibular osteotomy

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