Posterocentral approach to the knee: an alternative unified approach for the posterior quadrant tibial plateau fractures

Jaider A. Dávila-López, Departamento de Ortopedia y Traumatología, Hospital Universitario de Santander, Bucaramanga, Santander, Colombia
María I. Sepúlveda-Rivas, Departamento de Ortopedia y Traumatología, Hospital Universitario de Santander, Bucaramanga, Santander, Colombia
Johnnatan Franco-Henao, Departamento de Ortopedia y Traumatología, Hospital Universitario de Santander, Bucaramanga, Santander, Colombia
María F. Ochoa-Ariza, Departamento de Ortopedia y Traumatología, Hospital Universitario de Santander, Bucaramanga, Santander, Colombia
Sergio R. Gómez-Villamizar, Departamento de Ortopedia y Traumatología, Hospital Universitario de Santander, Bucaramanga, Santander, Colombia

Tibial plateau fractures originate primarily from high-energy trauma, most of which require surgical management. They represent a complex and multidimensional clinical challenge in orthopedics, given their impact on knee function and stability. We present a case of a 38-year-old woman who presented with a high-energy traffic accident as a passenger on a motorcycle, resulting in trauma to her left knee, accompanied by pain, swelling, and gait limitations. X-rays and a computed tomography scan documented a bicondylar tibial plateau fracture (Schatzker V) with posterior plateau involvement. She was a candidate for surgical management using a posterocentral knee approach. In the case documented here, the posterocentral knee approach allows direct visualization and improved accessibility to posterior quadrant fractures, facilitating fracture reduction and fixation with less soft tissue manipulation. Among the advantages are a lower incidence of skin and soft tissue complications compared to more invasive approaches, as well as less joint disruption. Additionally, the posterocentral approach minimizes disruption to the anterior compartment of the tibia, which can be beneficial for preserving function and reducing recovery time.

Keywords: Tibial plateau fractures. Posterior quadrant. Surgical approach. Intergastrocnemius.