German Congress of Orthopaedics and Traumatology (DKOU 2025)
Improved radiologic and functional outcomes in severe lateral tibial plateau fractures with lateral epicondyle osteotomy: A retrospective cohort study
2University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Anatomy, Christian-Albrechts-University, Kiel, Deutschland
3Asklepios Klinik St. Georg, Zentrum für Muskuloskelettale und Plastische Chirurgie Unfallchirurgie, Orthopädie und Sportorthopädie, Hamburg, Deutschland
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Objectives and questions: Does the use of lateral epicondyle osteotomy (ECO) in the surgical treatment of severe lateral tibial plateau fractures involving the central and postero-lateral regions lead to improved clinical and radiological outcomes compared to a conventional approach without the extension?
Material and methods: A retrospective cohort study was conducted at two centers, examining complex lateral tibial plateau fractures treated with either an extended lateral approach with ECO or without it. Only AO/OTA type B3/C3 fractures involving the antero-latero-central (ALC) and postero-latero-central (PLC) segments were included. Fracture reduction quality was assessed via post-operative CT scans, and clinical outcomes and complications were evaluated over a minimum of 24-month follow-up.
Results: A total of 110 patients (mean age: 51.3 ± 11.1 years) were included, with an average follow-up of 52.7 ± 16.9 months. The ECO group (n=56) consisted of more severe injuries, indicated by higher external fixator use (48.2% vs. 22.2%, p=0.0044) and additional affected segments. Postoperative CT scans revealed that the ECO group had significantly less fracture step-off (0.8 mm vs. 3.0 mm, p=0.0002) and angulation at the ALC/PLC (8.1° vs. 20.1°, p=0.0002) segment and PLC/PLL (postero-latero-lateral) (2.2° vs. 7.5°, p=0.02) segments. Clinically, the ECO group achieved superior IKDC scores (71.7 vs. 63.7, p=0.0097). A negative correlation was found between postoperative ALC/PLC depression and IKDC scores (r=-0.36, p=0.0002).
Discussion and conclusion: Patients treated with ECO had a significantly better clinical and radiologic postoperative outcomes, with the quality of fracture reduction positively correlating with the clinical IKDC score. This was achieved despite more severe injuries, as indicated by higher external fixator use and number of affected segments.
