Title : Outcomes of tibial plateau fracture fixation using a posteromedial (lobenhoffer) approach: A single-surgeon case series of 20 patients
Abstract:
Aims: To assess clinical, radiographic and patient-reported outcomes after tibial plateau fracture fixation using a Computed Tomography (CT)-guided three-column strategy incorporating a posteromedial (Lobenhoffer) approach.
Methods: This retrospective single-centre cohort study included 20 consecutive adults who underwent operative fixation of tibial plateau fractures between July 2020 and January 2022. Fractures were classified using Schatzker and CT-based three-column systems. Surgical approach and fixation constructs were selected according to column involvement. Outcomes at minimum six months included pain (visual analogue scale, VAS), Oxford Knee Score (OKS), 12-item Short Form Survey physical and mental component scores (SF-12 PCS and MCS), knee range of motion (ROM), radiographic maintenance of reduction and complications.
Results: Mean age was 50.2 years; 13 of 20 patients were female. Ten fractures involved one column, seven two columns and three all three columns. Mean time to theatre was 9.8 days and mean post-operative stay was 5.3 days. Mean follow-up 14.4 months, with a minimum of 6 months. Mean VAS pain score was 2.2/10 and mean OKS was 31.5. Mean SF-12 PCS was 40.9 and MCS was 44.3. All patients achieved at least 90 degrees of flexion at a mean follow-up of 12.6 months. Eighteen of 20 patients showed no further articular depression; two had 2 mm joint line depression.
Conclusion: A CT-guided, column-based fixation strategy incorporating a posteromedial Lobenhoffer approach achieved low pain, satisfactory function, preserved range of motion and stable reduction in a heterogeneous tibial plateau cohort.
