Fibular head osteotomy: A new technique for better exposure of postero-lateral tibial plateau fracture.

Objective: Various osteotomy techniques have been explored for exposing the posterolateral tibial plateau in previous studies. However, these methods are often complex, cause significant damage to normal anatomical structures, compromise knee joint stability, and pose risks to knee function, thus limiting their clinical application. This study proposes a new fibular head osteotomy technique for treating posterolateral tibial plateau fractures, aiming to achieve favorable surgical outcomes.

Methods: Thirteen patients who underwent surgical treatment for posterolateral tibial plateau fractures between March 2020 and August 2023 at our hospital were included in this study. The study was approved by the clinical ethics committee of our institution. All patients provided informed consent before participation. Surgeries were performed through a modified Frosch approach combined with partial fibular head osteotomy, while preserving part of the biceps femoris tendon attachment to the fibula. Postoperative fracture reduction quality was assessed using X-rays and computed tomography (CT) scans, in accordance with the Rasmussen radiology scoring system. Knee joint function was evaluated at the final follow-up using the Hospital for Special Surgery (HSS) scoring system. The healing of the fibular head osteotomy site and the presence of any complications were also assessed.

Results: All 13 patients were followed up with for an average of 12.2 months (range: 9-17 months). All fractures, collapse, and deformities were corrected. The mean Rasmussen radiological score was 15.5 ± 2.5 (range: 10-18), with four cases rated as excellent, eight as good, and one as fair. The mean Hospital for Special Surgery (HSS) score was 89.8 ± 6.4 (range: 78-98), with 10 cases rated as excellent and 3 as good. No posterolateral knee instability was observed during physical examination at the final follow-up. There were no complications such as surgical site infection or common peroneal nerve injury.

Conclusions: Partial fibular head osteotomy combined with preservation of the biceps femoris tendon attachment is an effective technique for treating posterolateral tibial plateau fractures. This method allows for successful fracture reduction and fixation without compromising knee joint function.