Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献

{"title":"Use of minimally invasive techniques to optimize the reduction of extracapsular proximal femur fractures: Indications and outcomes. Our treatment algorithm.","authors":"J M García López, J A Guerrero Serrano, A de la Fuente Palomo, M Sintes Álvarez-Arenas, A Capel Agundez, A Ortega Briones","doi":"10.1016/j.recot.2026.10.017","DOIUrl":"https://doi.org/10.1016/j.recot.2026.10.017","url":null,"abstract":"<p><strong>Introduction: </strong>Pertrochanteric fractures are among the most common conditions in trauma surgery, and the treatment of choice is closed reduction and internal fixation. The main predictor of a good functional outcome is the quality of reduction; therefore, open reduction is often required. The primary objective of this study was to analyse the outcomes regarding reduction quality in pertrochanteric fractures requiring open reduction and to describe the techniques used through our treatment algorithm.</p><p><strong>Materials and methods: </strong>A retrospective descriptive study was conducted including all patients with pertrochanteric fractures treated with intramedullary nailing who required open reduction between 2022 and 2024 at a tertiary care hospital. Demographic variables, fracture characteristics, surgical techniques, functional outcomes, and complications were collected. Radiological reduction quality was assessed according to the Baumgaertner and Kim modified classification, which categorizes reduction into three levels.</p><p><strong>Results: </strong>During the study period, a total of 1,034 fractures were surgically treated, of which 100 met the inclusion criteria (9.7%). Seventy-four percent of patients were women, with a mean age of 81 years. The most frequent fracture subtype was AO classification 31-A3.3. Satisfactory reduction was achieved in 75% of cases. Poor reduction was observed in 25% of patients with 31-A3.3 fractures. In 74% of patients, a Hohmann retractor and/or Verbrugge clamp were used. The overall complication rate was 13%, being more frequent in cases with poor reduction.</p><p><strong>Conclusion: </strong>AO 31-A2 and 31-A3 pertrochanteric fractures often present difficulties in achieving adequate reduction and frequently require open reduction techniques. These manoeuvers are summarized in our treatment algorithm.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key determinants of overnight hospital stay after total hip arthroplasty.","authors":"E Muñoz-Mahamud, A Combalia, A Alías, A Serra, I J Prats-Gimeno, J A Fernández-Valencia","doi":"10.1016/j.recot.2026.10.018","DOIUrl":"https://doi.org/10.1016/j.recot.2026.10.018","url":null,"abstract":"<p><strong>Objectives: </strong>Total hip arthroplasty (THA) is a highly effective procedure, with demand projected to increase significantly due to population ageing. Fast-track protocols aim to optimize perioperative management, enhance recovery, and reduce length of stay (LOS). However, LOS variability remains a concern. This study aimed to evaluate the influence of perioperative factors on LOS in patients undergoing primary THA at our institution.</p><p><strong>Methods: </strong>This retrospective cohort study at a single tertiary-care center included a stratified random sample of 300 primary THAs performed between January 2018 and December 2022 (100 per surgical approach: direct lateral [DL], posterolateral [PL], direct anterior [DAA]). Collected variables were age, sex, BMI, ASA class, laterality, surgical approach, use of tranexamic acid, preoperative laboratory values (hemoglobin, hematocrit, albumin, glucose), chronic anticoagulation, and surgical timing. The primary outcome was length of stay (LOS); prolonged LOS was defined as > 1 postoperative night. Continuous variables were compared using Student's t-test or the Mann-Whitney U test, and categorical variables using the Chi-square test. Statistical significance was set at P ≤ .05. The statistical analysis was primarily descriptive and exploratory, focusing on identifying associations between perioperative variables and prolonged length of stay.</p><p><strong>Results: </strong>Among the 300 patients, 142 (47.3%) were discharged after an overnight stay, whereas 158 (52.7%) experienced prolonged LOS. Female sex (P = .003), lower preoperative hemoglobin and hematocrit levels (P < .001), and chronic anticoagulant therapy (P = .01) were significantly associated with prolonged LOS. Conversely, the DAA was associated with shorter LOS (P < .001).</p><p><strong>Conclusion: </strong>Prolonged LOS was associated with female sex, anemia, and chronic anticoagulant therapy. Likewise, the DAA was associated with a shorter LOS, although these findings should be interpreted with caution due to the retrospective and exploratory nature of the study.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total knee arthroplasty: use of robotic surgery versus conventional surgery: Scoping review.","authors":"E Jiménez, K Quelal, J Ortiz","doi":"10.1016/j.recot.2026.10.019","DOIUrl":"https://doi.org/10.1016/j.recot.2026.10.019","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis is a leading cause of disability. Although total knee arthroplasty (TKA) is cost-effective, up to 20% of patients remain dissatisfied. Computer-assisted surgery (CAS), including navigation and robotic-assisted techniques, aims to improve alignment accuracy and surgical reproducibility.</p><p><strong>Objetive: </strong>To compare radiological, clinical, and functional outcomes between conventional and computer-assisted primary TKA.</p><p><strong>Methods: </strong>A scoping review was conducted according to PRISMA-ScR guidelines. A comprehensive search of PubMed/MEDLINE, EMBASE, and Cochrane databases (2011-2024) was performed using MeSH and DeCS terms derived from the PICO question. Randomized controlled trials, systematic reviews, and meta-analyses comparing conventional and CAS techniques were included. Twenty-three studies met inclusion criteria after independent paired screening.</p><p><strong>Results: </strong>Navigation and robotic-assisted TKA achieved significantly improved mechanical axis alignment and reduced proportion of alignment outliers (>± 3°) compared with conventional TKA. Registry data suggest lower revision rates with navigation in patients younger than 65 years. Both CAS modalities demonstrated reduced systemic inflammatory response and less intraoperative soft tissue injury. However, no significant differences were found in long-term implant survivorship or functional outcomes at ≥10 years follow-up. Robotic-assisted TKA was associated with longer operative time and higher intraoperative costs, with conflicting evidence regarding overall cost-effectiveness.</p><p><strong>Conclusions: </strong>CAS improves radiological accuracy and reproducibility in primary TKA but does not demonstrate superior long-term functional outcomes compared with conventional techniques. Clinical adoption should be individualized based on surgeon experience, institutional volume, patient comorbidities, and economic considerations.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of Hip Fractures in the Elderly. A Public Health Problem. II. Interventions.","authors":"E Guerado, D González-Quevedo, Gomez-Palomo Jm, J R Cano, J M Sánchez-Siles, I Tamimi","doi":"10.1016/j.recot.2026.10.020","DOIUrl":"https://doi.org/10.1016/j.recot.2026.10.020","url":null,"abstract":"<p><p>The prevention of hip fractures relies on avoiding falls and preserving, as much as possible, the muscle and bone mass acquired during youth, in addition to addressing other risk factors. Regular physical exercise and proper nutrition are fundamental for osteosarcopenia prevention. However, these topics are heavily influenced by the social and economic circumstances of a population subjected to persistent inflation that is not offset by a proportional increase in income to afford adequate food, especially in elderly people. Meanwhile, for hip fracture prevention the state provides free access to medications of questionable effectiveness that can cause serious side effects. Policies aimed at reducing poverty and social exclusion would constitute a fundamental component of population prevention strategies.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Use of uncemented modular diaphyseal stems in salvage hip replacement after cut-out failure of cephalomedular fixation for extracapsular hip fractures. Monocentric series.","authors":"I Martínez Pérez, C López-Orosa","doi":"10.1016/j.recot.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.recot.2026.10.009","url":null,"abstract":"<p><strong>Background and objective: </strong>There are different treatments for cut-out failure after intramedullary nailing in hip fractures. Salvage with hip arthroplasty is an accepted method in frail elderly patients and in cases of articular cartilage damage or compromised bone stock precluding re-osteosynthesis. However, this is not without complications (10-66%) due to its complexity.</p><p><strong>Material and methods: </strong>A single-center retrospective case series of patients treated with salvage arthroplasty using an uncemented modular diaphyseal fixation stem (Arcos® system, Zimmer Biomet). Minimum follow-up was 1 year.</p><p><strong>Results: </strong>Fourteen cases were recorded, nine after Gamma3® nailing and five after Intertan® nailing. The posterolateral approach was the most commonly used (10 cases). Eight total hip replacements, three double mobility replacements, and six bipolar hemiarthroplasties were implanted. At 30 days, 92.9% were able to walk indoors with technical support. During the first year, six patients (42.8%) had complications related to the implant: three periprosthetic fractures, one acetabular erosion, and three dislocations. No patients died during hospitalization or at 30 days; one patient (7.1%) died within a year.</p><p><strong>Discussion and conclusion: </strong>Prosthetic salvage after cut-out with uncemented modular diaphyseal stems is a complex surgery with a significant risk of complications, especially dislocation and periprosthetic fracture. These implants allow the deficient proximal areas to be by-passed and restore the length, version, and offset, making them a possible alternative in selected patients, although not without complications.</p><p><strong>Evidence level: </strong>Level IV.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Comparison of peroneus longus and hamstring autografts in ACL reconstruction: Graft diameter and donor-site morbidity analysis.","authors":"M A Abdelmoeti, A M Nahla, A M Elshaer","doi":"10.1016/j.recot.2026.10.014","DOIUrl":"https://doi.org/10.1016/j.recot.2026.10.014","url":null,"abstract":"<p><strong>Background: </strong>Surgeons increasingly consider the peroneus longus tendon an effective alternative to hamstring autografts for anterior cruciate ligament reconstruction (ACLR). Choosing the right graft critically impacts long-term knee stability, prompting surgeons to strictly avoid undersized tissues. This study retrospectively compared clinical outcomes, knee stability, and comprehensive donor-site morbidity in ACLR utilizing peroneus longus versus hamstring tendon autografts.</p><p><strong>Methods: </strong>We evaluated 30 patients undergoing arthroscopic ACLR in this retrospective review. The cohort was divided equally into hamstring tendon group (n=15), initially prepared as 4-strand constructs and augmented to 6 strands when intraoperative sizing fell below 7.5 mm and a peroneus longus graft group (n=15), prepared as 2-strand constructs. One senior surgeon applied the identical surgical technique, fixation method, and postoperative protocol across both groups. We assessed functional outcomes (Lysholm and IKDC scores) at a minimum 2-year follow-up and measured graft diameters intraoperatively. To evaluate donor-site morbidities, we recorded thigh circumference, AOFAS scores, FADI scores, and ankle range of motion (ROM).</p><p><strong>Results: </strong>All 30 patients completed at least two years of follow-up (range 24-31 months). Statistically, the two cohorts showed comparable clinical outcomes and overall knee stability (P > 0.05). Initial peroneus longus diameter (mean 8.71 mm) exceeded initial hamstring diameter (mean 7.65 mm) (P<0.001); 6 cases augmented to 6 strands reached a final mean of 8.2 mm. Furthermore, ankle assessments (AOFAS, FADI, and ROM) revealed no joint dysfunction or sports restrictions in the peroneus longus patients.</p><p><strong>Conclusion: </strong>Peroneus longus patients experienced less anteromedial knee pain and notably less thigh hypotrophy than the hamstring group. Given its larger structural diameter and comparable short-term clinical outcomes, the peroneus longus tendon serves as a robust and viable alternative autograft for ACLR.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] What's new in spinal instrumentation-related infections.","authors":"A Ortega-Yago, P Rubio, P Ulldemolins, J Baeza-Oliete, P Bas, T Bas","doi":"10.1016/j.recot.2026.10.016","DOIUrl":"https://doi.org/10.1016/j.recot.2026.10.016","url":null,"abstract":"<p><p>Infections associated with spinal instrumentation represent one of the most complex complications in spine surgery and frequently involve biofilm-forming pathogens that compromise the effectiveness of antimicrobial therapies. Diagnosis - particularly in chronic cases - requires the use of advanced microbiological techniques, such as implant sonication, next-generation metagenomic sequencing, and prolonged culture incubation. Therapeutic strategies depend on the chronicity of the infection and the stability of the implant, ranging from surgical debridement with retention of osteosynthesis material to staged delayed re-instrumentation. Empirical antibiotic therapy should be initiated promptly and subsequently adjusted according to microbiological results. Prevention remains a fundamental pillar and includes strict perioperative optimization. Favorable outcomes rely on early detection, a multidisciplinary team approach, and individualized surgical and antimicrobial management based on accurate clinical and radiological assessment.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Clinical and functional outcomes of unilateral biportal endoscopic decompression in patients with lumbar compression.","authors":"Fernando Torres Romero, Estefanny Trilleras Vargas, Camilo Velandia-Amaya","doi":"10.1016/j.recot.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.recot.2026.10.006","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar neural compression is one of the leading causes of pain and disability in older adults. Unilateral Biportal Endoscopic (UBE) decompression has emerged as a minimally invasive alternative to conventional techniques, providing a wider surgical field, enhanced visualization, and preservation of anatomical structures.</p><p><strong>Methods: </strong>We conducted a retrospective observational study including patients with lumbar spinal stenosis who underwent decompression using the UBE technique between January 2022 and January 2024. Demographic data, surgical details, and clinical and functional outcomes were analyzed using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), length of hospital stay, and medical leave duration.</p><p><strong>Results: </strong>A total of 98 patients were included, with a mean age of 65 ±10 years and a predominance of females. Mean VAS scores decreased from 8.0 ±1.0 preoperatively to 4.0 ±1.0 postoperatively (p < 0.001), while ODI scores improved from 50 ±10 to 20 ±5 (p < 0.001). Hemoglobin levels showed a moderate but significant reduction (14 ±1.0 g/dL to 12 ±1.0 g/dL; p < 0.001). Hospital stay ranged from 1 to 4 days, with most cases requiring only 1-2 days, and mean medical leave duration was 1.3 ±0.6 months. The complication rate was low, with no major adverse outcomes.</p><p><strong>Conclusions: </strong>UBE decompression has shown a safe and effective minimally invasive technique for the management of lumbar neural compression. It provides significant improvements in pain and function, shortens hospital stay, and supports early recovery, reinforcing its role as a valuable therapeutic option in clinical practice.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Preoperative weight-adjusted dexamethasone in total knee arthroplasty: Optimizing analgesic efficacy and safety.","authors":"Julián Carlos Segura-Nuez, Fernando Martínez-Delgado, Silvia Aldabas-Soriano, María Jesús Caballero-Burbano","doi":"10.1016/j.recot.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.recot.2026.10.002","url":null,"abstract":"<p><p>Background Total knee arthroplasty (TKA) is frequently associated with moderate to severe postoperative pain. Dexamethasone (DEX) is widely used as part of multimodal analgesia, although the optimal dose remains uncertain. This study compared the analgesic efficacy of a weight-adjusted intermediate DEX dose (0.3 mg/kg) with a fixed 8 mg dose. Methods In this retrospective cohort study, 577 patients undergoing primary TKA between January 2021 and December 2024 received either 0.3 mg/kg DEX (n = 305) or a fixed 8 mg dose (n = 272) preoperatively. Pain was assessed using a numerical rating scale (NRS, 0-10 points) and the number of 5 mg oxycodone rescue doses at 24 and 48 h postoperatively. C-reactive protein (CRP) and blood glucose were measured at 24 h. Multivariate analyses evaluated the association of age, sex, and DEX dose with pain outcomes. Results Patients receiving 0.3 mg/kg DEX reported significantly lower pain scores than those receiving 8 mg, with mean differences of 1.13 NRS points at 24 h and 1.17 points at 48 h (p < 0.001). Oxycodone rescue use was reduced at both time points (p < 0.001). Older age and male sex were independently associated with lower pain scores. CRP levels at 24 h were lower in the weight-adjusted group, whereas postoperative glucose levels were higher (both p < 0.05). Length of stay did not differ significantly between groups. Conclusion A preoperative, weight-adjusted dexamethasone dose of 0.3 mg/kg provides superior early postoperative analgesia compared with a fixed 8 mg dose after TKA, reducing pain scores and opioid requirements during the first 48 h.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Versatile Extended Anterolateral (EAL) Approach with a progressive four-window strategy for posterolateral column management in tibial plateau fractures: A detailed cadaveric study.","authors":"Juan Boluda-Mengod, Beatriz Olías-López, Pau Forcada-Calvet, Azucena Martín-Herrero, Eduardo Morales-Mata, José Luis Pais-Brito, Mario Herrera-Pérez","doi":"10.1016/j.recot.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.recot.2026.10.005","url":null,"abstract":"<p><p>Background The posterolateral (PL) column is often the most difficult one to access and manage in tibial plateau fractures. Although multiple approaches have been described, many provide limited flexibility to address diverse fracture patterns. The Versatile Extended Anterolateral (EAL) Approach with four progressive windows has been previously introduced within the Main Deformity Direction (MDD) framework. In this cadaveric study, we provide a detailed anatomical and technical description of this modified approach, characterized by an optimized skin incision and four stepwise deep windows for PL column management. The primary aim was to assess the technical feasibility of this approach. Potential reduction and fixation options associated with each window were also explored descriptively. Materials and methods Four fresh-frozen cadaveric specimens were used to evaluate surgical exposure and relationships with relevant anatomical structures. Based on the anatomical exposure achieved with each window, potential reduction and fixation strategies were explored descriptively. Representative clinical cases were included to illustrate fixation techniques. Results The skin incision allowed access to all windows, achieving safe progressive PL column exposure. The four windows (pre-fibular, supra-fibular, retro-fibular, trans-fibular) expanded reduction and fixation possibilities stepwise. The trans-fibular window enabled complete articular and metaphyseal exposure. The anterior tibial artery crossing, located at a mean of 3.5 cm from the tip of the fibular head, represented the distal anatomical limit of posterior exposure. Conclusion The versatile EAL Approach is a feasible option for managing lateral and PL columns in tibial plateau fractures. Its progressive four-window strategy may allow tailored exposure and fixation according to fracture-specific requirements.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}