Fractures of the tibial condyles: current treatment methods and surgical approaches (literature review)
The review of the specialized literature showed that the incidence of intra-articular tibial condylar fractures that are located in the posterior tibial parts is rather high. However, the most commonly used classifications do not always provide with an accurate architectonics of such fractures. Therefore, three- and four-column classifications of the discussed fractures were proposed. Accurate reduction of bone fragments of the posterior tibial plateau from the standard approaches is rather difficult technically due to an inadequate visualization of the fracture zone. Thus, posterolateral and posterior approaches to the tibial plateau were introduced through which not only the visualization of the posterior tibial plateau structures but also their osteosynthesis with a support plate is possible. The authors analyzed the scientific publications related to the main surgical approaches to the tibial plateau and their use for osteosynthesis of the fractures in this area. It appeared that the most adequate reduction and fixation of the fragments of the posterior tibial plateau is provided by posterolateral and posterior approaches. Despite the risk of damage to major vessels and nerves by using these approaches their widespread introduction in practice is promising. However, further scientific studies are required that would be aimed at substantiation and improvement of the techniques of the posterior approach to the knee as well as at updating the indications for each of them.