gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2021)

26. - 29.10.2021, Berlin

Operative strategy of atypical irreducible posterolateral quadrant dislocation in proximal tibial fracture with entrapment of the popliteal tendon

Meeting Abstract

  • presenting/speaker Frederic Thiele - Departement Chirurgie, Kantonsspital Graubünden, Chur, Switzerland
  • Christian Michelitsch - Departement Chirurgie, Kantonsspital Graubünden, Chur, Switzerland
  • Philipp Florian Stillhard - Departement Chirurgie, Kantonsspital Graubünden, Chur, Switzerland
  • Christoph Sommer - Departement Chirurgie, Kantonsspital Graubünden, Chur, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2021). Berlin, 26.-29.10.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocAB78-765

doi: 10.3205/21dkou536, urn:nbn:de:0183-21dkou5365

Published: October 26, 2021

© 2021 Thiele et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Lateral tibial plateau fractures are commonly seen in central trauma units whereas the posterolateral fractures of the tibial plateau are relatively rare. Additionally, an irreducible posterolateral quadrant dislocation (PLQD) is unfrequently. To our knowledge this fracture pattern is not specifically described in the literature. Achieving an anatomical reduction using a standard anterolateral approach is impossible. Therefore, we present four atypical cases where PLQD was irreducible because of an entrapment of the popliteal tendon.

Methods: We performed a retrospective single center cohort review at our trauma unit. During a period of 10 years we performed surgery on 555 proximal tibia fractures (AO 41) while we only stated 4 cases of an irreducible PLQD with entrapment of the popliteal tendon (0.7%). The mean age was 52.3 years, two female patients with a partial intraarticular fracture (AO 41-B3) and two male patients with a complete intraarticular fracture (AO 41-C3). Computertomography images were used to classify the fracture types after initial stabilization with a knee bridging external fixator. In all cases we performed open reduction and internal fixation with locking compression plates (LCP) using a transfibular approach. Intraoperatively the interposition of the popliteal tendon was located, looped with a rubber band and with tension on the tendon the fragment could be reduced anatomically.

Results and Conclusion: In all four cases an anatomical restoration of the joint line was possible after releasing the entrapped popliteal tendon. Clinical and x-ray follow-up was done at six and twelve weeks and one year after surgery in the outpatient department. No complications like infection, re-operation or non-union were recorded. One patient was lost to follow up one year postoperatively, the remaining 3 patients presented with a healed fracture and no limitation in range motion.

PLQD is often challenging to reduce anatomically. As these cases have shown, we recommend reducing these fractures through a transfibular approach to have visual insight into the fracture zone for releasing the entrapped popliteal tendon. Thus, an awareness of this fracture pattern such as we reported in the present cases, is important for all surgeons treating proximal tibial fractures.