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Objective <p>This study aimed to investigate the indications and clinical effects of the Frosch approach versus the supra-fibular head approach in the treatment of posterolateral tibial plateau fractures combined with lateral column fractures (PTPL) on the basis of the morphological classification of the posterolateral cortex.</p> Methods <p>A retrospective analysis was conducted on patients treated between June 2018 and January 2024 for PTPL using either the Frosch approach (group A, <i>n</i> = 23) or the supra-fibular head approach (group B, <i>n</i> = 21). Fractures were classified according to the morphology of the posterolateral cortex into two types: intact cortex (type I, <i>n</i> = 24) and disrupted cortex (type II, <i>n</i> = 20). Patients with type I fractures were further divided into subtypes IA (Frosch, <i>n</i> = 12) and IB (supra-fibular head, <i>n</i> = 12), and those with type II fractures into IIA (Frosch, <i>n</i> = 11) and IIB (supra-fibular head, <i>n</i> = 9). Baseline characteristics and perioperative parameters were compared. Clinical effects was assessed using the Rasmussen radiological score, and knee function was evaluated using the Rasmussen functional score.</p> Results <p>The operative time was significantly longer in group A than in group B (130.0 ± 19.1 versus 110.1 ± 13.7&#xa0;min, <i>P</i> &lt; 0.05). In the type I subtype, operative time was longer in IA than in IB (138.3 ± 19.5 versus 111.9 ± 17.4&#xa0;min, <i>P</i> &lt; 0.05). In the type II subtype, operative time was significantly longer in IIA compared with IIB (120.9 ± 14.5 versus 107.8 ± 6.7&#xa0;min, <i>P</i> &lt; 0.05). Rasmussen radiological scores were significantly higher in IIA than IIB (17.6 ± 1.2 versus 17.0 ± 0.9, <i>P</i> &lt; 0.05); similarly, functional scores were higher in IIA than IIB (29.1 ± 1.8 versus 27.7 ± 1.7, <i>P</i> &lt; 0.05).</p> Conclusions <p>Morphology-based classification of PTPL—according to the integrity of the posterolateral cortex—can provide valuable guidance for surgical decision-making. For fractures with cortical disruption, the Frosch approach offers superior reduction and enhanced stability. In contrast, for fractures with intact cortical continuity, the supra-fibular head approach is a less invasive and technically straightforward alternative with favorable clinical outcomes.</p> <p><i>Level of evidence</i>: III, retrospective study.</p>

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Comparison of the Frosch approach and the supra-fibular head approach in the treatment of posterolateral tibial plateau fractures combined with lateral column fractures

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  • 发表日期：

    2025年11月11日

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  • Lei Wang,
  • Xiangyang Dai,
  • Xuening Dai,
  • Ding Yue,
  • ChengPu Zhong,
  • YaLi Wen,
  • Jian Qin,
  • Tangbo Yuan

摘要

Objective

This study aimed to investigate the indications and clinical effects of the Frosch approach versus the supra-fibular head approach in the treatment of posterolateral tibial plateau fractures combined with lateral column fractures (PTPL) on the basis of the morphological classification of the posterolateral cortex.

Methods

A retrospective analysis was conducted on patients treated between June 2018 and January 2024 for PTPL using either the Frosch approach (group A, n = 23) or the supra-fibular head approach (group B, n = 21). Fractures were classified according to the morphology of the posterolateral cortex into two types: intact cortex (type I, n = 24) and disrupted cortex (type II, n = 20). Patients with type I fractures were further divided into subtypes IA (Frosch, n = 12) and IB (supra-fibular head, n = 12), and those with type II fractures into IIA (Frosch, n = 11) and IIB (supra-fibular head, n = 9). Baseline characteristics and perioperative parameters were compared. Clinical effects was assessed using the Rasmussen radiological score, and knee function was evaluated using the Rasmussen functional score.

Results

The operative time was significantly longer in group A than in group B (130.0 ± 19.1 versus 110.1 ± 13.7 min, P < 0.05). In the type I subtype, operative time was longer in IA than in IB (138.3 ± 19.5 versus 111.9 ± 17.4 min, P < 0.05). In the type II subtype, operative time was significantly longer in IIA compared with IIB (120.9 ± 14.5 versus 107.8 ± 6.7 min, P < 0.05). Rasmussen radiological scores were significantly higher in IIA than IIB (17.6 ± 1.2 versus 17.0 ± 0.9, P < 0.05); similarly, functional scores were higher in IIA than IIB (29.1 ± 1.8 versus 27.7 ± 1.7, P < 0.05).

Conclusions

Morphology-based classification of PTPL—according to the integrity of the posterolateral cortex—can provide valuable guidance for surgical decision-making. For fractures with cortical disruption, the Frosch approach offers superior reduction and enhanced stability. In contrast, for fractures with intact cortical continuity, the supra-fibular head approach is a less invasive and technically straightforward alternative with favorable clinical outcomes.

Level of evidence: III, retrospective study.