Lobenhoffer approach with direct reduction of posterior fracture fragments excellent option for complex tibial plateau fractures
Posterior tibial plateau fracture (PTPF) is caused when the femoral condyle strikes the posterior tibia plateau while the knee joint, in a semi-flexion or flexed position, suffers from a varus-valgus stress.
An article published in the European Journal of Orthopaedic Surgery & Traumatology has concluded that the Lobenhoffer approach with direct reduction of posterior fracture fragments for complex tibial plateau fractures is an excellent option for the management of these injuries with the advantage of faster surgery and improved range of motion.
In this study, researchers compared outcomes of patients with posterior tibial plateau fractures who underwent repair indirectly with an anterior approach to those who underwent direct repair with a prone “Lobenhoffer” operative approach.
Forty-four patients with posterior column tibial plateau fractures underwent repair, 22 of whom were fixed using a prone Lobenhoffer approach and compared to 22 patients with similar fracture patterns treated with indirect reduction using a supine approach. Data collection at a minimum of one year included patient-reported outcome scores, pain, knee range of motion, complications, need for reoperation and radiographs for knee alignment, residual depression and fracture healing.
Key findings from the research are:
- All demographics were similar between the groups except BMI, which was lower in the prone group.
- Fracture type according to age, Schatzker and three-column classification was matched between cohorts.
- The study reported no difference related to outcomes, including pain, radiographic knee alignment, residual articular depression, functional outcome (SMFA), complications and reoperation needs.
- In the prone group, Knee flexion at one year (127.8 vs. 115.8).
- Considering the prone group, the surgical time was less, with a mean of 73.7 min vs. 82.3 min.
Concluding further, they said that the Lobenhoffer approach with direct reduction of posterior fracture fragments is an excellent approach for managing such injuries. It allows faster surgery with improved ultimate knee range of motion in posterior column tibial plateau fractures.
Reference:
Schwartz, L., Ganta, A., Konda, S. et al. The prone posteromedial approach to the knee revisited: a safe and effective strategy for posterior tibial plateau fractures. Eur J Orthop Surg Traumatol (2023). https://doi.org/10.1007/s00590-023-03755-z
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