"Stepwise Supine Anterolateral Approach for Posterolateral Tibial Plateau Fracture With Intact Posterior Cortical Rim: A Case Report".

Abstract

Posterolateral tibial plateau fractures are technically demanding due to limited exposure imposed by the fibular head and posterolateral corner structures. The standard anterolateral approach visualizes only 36.6% of the posterolateral articular surface, contributing to malreduction rates reaching 32.3%. We report a 26-year-old female who sustained a Kfuri-Schatzker type 2 fracture with combined anterolateral and posterolateral involvement, characterized by depression of the posterior three-quarters of the lateral plateau with an intact posterior cortical rim. This morphology rendered posterior buttress plating not required for stability in this morphology, shifting the surgical priority toward maximizing articular visualization for direct reduction. A three-step extensile anterolateral approach was performed entirely in the supine position: first, Gerdy's tubercle osteotomy to mobilize the iliotibial tract; second, lateral femoral epicondyle osteotomy to release the lateral collateral ligament and popliteus tendon; and third, submeniscal arthrotomy with central meniscal subluxation. This sequential algorithm provided near-complete articular visualization, enabling anatomical reduction and stable fixation with subchondral rafting screws and a lateral locking plate. This case demonstrates the feasibility of a stepwise, supine extensile anterolateral strategy to maximize articular visualization for selected posterolateral tibial plateau fractures with an intact posterior cortical rim, while avoiding prone positioning and a dedicated posterior approach. LEVEL OF EVIDENCE: V.