Abstract
A critical assessment of radiographic and clinical outcomes after complex articular
fractures of the proximal tibia demonstrates several aspects worthy of reevaluation
and potential modification. These include a refined understanding of fracture pathoanatomy,
injury classification, operative exposure, surgical timing, and preferred fixation
constructs in addition to implant design modifications. Evolving trends include increasing
appreciation of the importance of the fracture morphology in the axial plane and the
role that the fracture pattern has on the choice of surgical approach. This focused
review will highlight the attributes and limitations of classification schemes (both
conventional and contemporary) as well as the role that posterior surgical approaches
performed in the prone position may offer in select clinical scenarios. The merits
of staged fixation (prone followed by supine patient positioning), its technique,
indications, and potential liabilities are described and case examples offered.
Keywords
staged - posterior - plateau - Lobenhoffer
