Treatment of hyperextension-type tibial plateau fractures: An effective reduction technique and fixation method

To introduce an effective reduction technique and fixation method for hyperextension-type tibial plateau fractures. A retrospective analysis was conducted on 67 cases of hyperextension-type tibial plateau fractures treated between January 2017 and June 2023, including 42 males and 25 females, aged 28 to 71 years (mean 55.43 years). Left knees were involved in 38 cases and right knees in 29 cases. Perioperative data, follow-up outcomes, and imaging were analyzed to evaluate the new reduction and fixation approach. Associated injuries included fibular head fractures (40 cases), lateral collateral ligament laxity (6 cases), complete lateral collateral ligament rupture (7 cases), grade III lateral meniscus injury (3 cases), and complete posterior cruciate ligament rupture (4 cases). One patient required late ligament reconstruction. Three cases of acute popliteal artery injury were successfully managed. Operative time averaged 118.4 ± 8.4 min, with blood loss of 159.1 ± 50.5 mL. All fractures united by 3.1 ± 0.5 months. Postoperatively, the posterior tibial slope (PTS) was corrected from −2.6° ± 1.9° to 7.12° ± 1.2° (mean correction 9.7° ± 1.5°), and the medial proximal tibial angle (mPTA) improved from 82.5° ± 3.6° to 86.3° ± 1.3° (mean correction 3.8° ± 3.6°), showing no significant difference from the healthy side (P > 0.05). Mean knee range of motion was 123.3° ± 10.6°, and the mean HSS knee score was 92.9 ± 3.5. The presence of an anterior cortical fragment shadow on lateral X-rays serves as an indirect sign of hyperextension-type tibial plateau fractures. The use of a Caspar distractor effectively restores the proximal tibial anatomical angles. Employing a medial proximal tibial locking plate maintains the posterior tibial slope effectively, yielding excellent clinical outcomes.