Outcomes of the Carlson Approach in the Treatment of Posterior Tibial Plateau Fractures

Alencar Neto, Jonatas Brito de; Rego, Itallo Epaminondas de Queiroz; Lopes, Márcio Bezerra Gadelha; Lima, Lana Lacerda de; Clazzer, Renata; Lima, Diego Ariel de

doi:10.1055/s-0042-1749200

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Original Article • Rev. bras. ortop. 58 (2) • Mar-Apr 2023 • https://doi.org/10.1055/s-0042-1749200 copy

Outcomes of the Carlson Approach in the Treatment of Posterior Tibial Plateau Fractures

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

To describe a series of cases of tibial fractures surgically treated using the posterior approach as described by Carlson, focusing on evaluating its functional results and complication rate.

Methods

Eleven patients with tibial plateau fractures, who underwent surgical treatment using the Carlson approach from July to December 2019, were followed-up. The minimum follow-up period was defined as 6 months. The American Knee Society Score (AKSS), American Knee Society Score/Function (AKSS/Function) and the Lysholm score were used to check treatment results at 6 months after the fracture. The patients underwent standard anteroposterior and lateral radiographs to assess fracture healing, and clinical healing was determined by the absence of pain during full weight-bearing.

Results

The mean follow-up period was 12 months (9-16 months). The primary mechanism of trauma was motorcycle accident, and the most prevalent side of fracture was the right side. Eight participants were male. The mean age of the patients was 28 years. All fractures healed, and none of the patients presented complications. The AKSS was excellent in 11 patients, with a mean AKSS/Function of 99.1±3, and Lysholm scores with a median of 95.0±5.6.

Conclusions

The Carlson approach for posterior fractures of the tibial plateau can be considered safe, presenting a low complication rate and satisfactory functional results.

Keywords
tibial fractures; surgical procedures, operative; rehabilitation

Patients	Age	Mechanism	Time until surgery (days)	Classification
Patients	Age	Mechanism	Time until surgery (days)	Shatzker	Schatzker/Kfuri	Moore	AO/ASIF	Luo
1	47	Motorcycle accident	3	III	V P ML	I	41B2.2	Posterior column (medial and lateral)
2	30	Motorcycle accident	1	III	V P ML	I	41B2.2	Posterior column (medial and lateral)
3	23	Sports trauma	3	IV	V P ML	V	41C.1	Posterior column (medial and lateral)
4	19	Motorcycle accident	5	III	V P ML	IV	41B2.3	Posterior column (medial and lateral)
5	28	Motorcycle accident	2	III	V P ML	I	41B2.3	Posterior column (medial and lateral)
6	41	Motorcycle accident	2	III	V P ML	IV	41B2.2	Posterior column (medial and lateral)
7	19	Motorcycle accident	4	V	V P ML	V	41C1	Posterior column (medial and lateral)
8	22	Motorcycle accident	9	III	V P ML	IV	41B2.2	Posterior column (medial and lateral)
9	28	Motorcycle accident	18	II	V P ML	II	41B3.1	Posterior column (medial and lateral)
10	29	Motorcycle accident	12	V	V P ML	V	41C1	Posterior column (medial and lateral)
11	22	Motorcycle accident	10	II	V P ML	I	41B2.2	Posterior column (medial and lateral)

Patients	Duration of surgery (in minutes)	Bone graft	Fixation type	Quality of the reduction	Complications
1	70’	No	3.5 T plate (lateral) +3.5 T plate (medial)	Anatomical	No
2	93’	No	3.5 T plate (lateral) +3.5 T plate (medial)	Anatomical	No
3	130’	Yes (iliac)	3.5 T plate (lateral) +3.5 T plate (medial)	Anatomical	No
4	100’	No	3.5 T plate (lateral) +3.5 T plate (medial)	Anatomical	No
5	112’	No	3.5 T plate (lateral) +3.5 T plate (medial) - locking	Anatomical	No
6	83’	Yes (synthetic)	3.5 T plate (lateral) +3.5 T plate (medial) + cannulated screw	Anatomical	No
7	97’	No	3.5 T plate (lateral) +3.5 reconstruction plate (medial) +3.5 reconstruction plate (central)	Anatomical	No
8	72’	No	3.5 T plate (lateral) +compression screws (medial)	3mm Lateral depression	No
9	107’	No	Cannulated screws (lateral) + reconstruction plate 3.5 (medial)	4mm lateral depression	Injury of the superficial branch of the fibular nerve
10	111’	No	3.5 T plate (lateral) + 3.5 reconstruction plate /com-pression screw (medial)	1mm lateral depression	No
11	125’	Yes (synthetic)	3.5 T plate/3.5 can-nulated screws (lateral) + 3.5 reconstruction plate (medial)	Anatomical	No

Patients	Lysholm^* * p = 0.0637.		AKKS^ p = 0.295. /AKKS Function^* ***** p = 0.6831.	ROM	Reduction/Alignment	Complications
	Pre-injury	6 months		ROM	Reduction/Alignment	Complications
1	100	90	96/100	0–117	Anatomical/Maintained	No
2	100	94	97/100	0–123	Anatomical/Maintained	No
3	100	85	90/100	0–115	Anatomical/Maintained	No
4	100	95	88/100	0–100	Anatomical/Maintained	No
5	100	99	100/100	0–125	Anatomical/Maintained	No
6	100	95	100/100	0–125	Loss of 2 mm/ Maintained	No
7	100	99	95/100	0–125	Anatomical/Maintained	No
8	100	84	92/90	0–113	3 mm lateral depression/ Maintained	No
9	100	85	95/100	0–123	4 mm lateral depression/ Maintained	No
10	100	96	100/100	0–125	1 mm lateral depression/ Maintained	No
11	100	96	100/100	0–125	Anatomical/Maintained	No

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Diego Ariel de Lima, MD, PhD, Federal Rural University of the Semi-arid Region, Francisco Mota Street, 572, Pres. Costa e Silva, Mossoró, RN, 59625-900, Brazil (e-mail: arieldelima.diego@gmail.com).