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Direct Access to the Proximal Posteromedial Tibia for Fixation of Large Posteromedial Tibial Fractures Utilizing the “Lobenhoffer Approach” in Lateral Decubitus Position
Keywords:
Anatomical reduction, Hohl and Moore, Lobenhoffer, Posteromedial, Schatzker.Abstract
Objective: To determine the effectiveness and safety of “Lobenhoffer approach” for treating large posteromedial tibial fractures of the proximal tibia.
Methods: The descriptive study was carried out from 23rd January 2017 to 25th December 2019 at Qaisrani Medical Center (QMC) Multan. All patients of proximal tibia fractures having a large posteromedial plateau fragment alone or in combination with bicondylar fractures (Hohl and Moore type I /Schatzker type IV) fulfilling the inclusion criteria were operated with Lobenhoffer approach. Fracture reduction was confirmed by per-op visualization with image intensifier and post operatively with radiographs. The radiological reduction was anatomical if fracture was accurately reduced without any step and non anatomical if step was noted(? 2mm).The patients were followed up for one year and radiological evaluation, functional assessment and any potential complication was documented. Comparison of important outcome variables were made and P value was calculated with the help of Chi square test (P value < 0.05 was considered significant)
Results: A total of 15 patients were included in our study. The mean age was 36.73± 10.9 years (range 18 to 56 years). Posteromedial and bicondylar fracture was present in 12(80%) patients while 3(20%) patients had isolated posteromedial fracture. Immediate post operative radiographs revealed anatomical reduction in 12(80%) and non anatomical reduction in 03(20%) patients (P >0.05). No per operative or immediate post operative complication was noted. Union was achieved in all patients. Majority(73.3%,n=11) patients achieved full range of knee motion, only 1(6.6% ) patient had extension lag of 10 degrees( P < 0.05 ). Grade II osteoarthritis was noted in 2(13.3%) patients(P >0.05).
Conclusion: Accurate anatomical reduction and excellent functional outcome can be achieved by fixing posteromedial tibial fractures through Lobenhoffer approach in lateral decubitus position. It is a safe approach and has no major per operative or post operative complications. We recommend this approach for all proximal tibial fractures with posteromedial fragment.
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