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Background <p>Schatzker type IV total medial plateau fractures with posterolateral articular surface collapse, abbreviated as Schatzker IV-TMP/PLC, present a complex surgical problem. The intact anterolateral rim obstructs conventional access to the posterolateral depression, while the frequent entrapment of the lateral meniscus adds a critical soft-tissue dimension to the challenge. This study describes and evaluates a anterior limited open incision that is designed to utilize the main fracture line as a direct corridor for addressing both the osseous and soft-tissue components of this injury.</p> Objective <p>To evaluate the efficacy and outcomes of the anterior auxiliary limited open incision in the treatment of Schatzker IV-TMP/PLC fractures.</p> Methods <p>In this retrospective study, fifteen patients with Schatzker IV-TMP/PLC fractures were treated with the anterior auxiliary limited open incision, which facilitated direct reduction of the collapsed posterolateral articular surface and any trapped lateral meniscus. Perioperative parameters including waiting time, blood loss, and operation time were recorded. Postoperative follow-up was performed to assess complications, fracture healing time, muscle strength, sensation, limb length, lower limb alignment, knee range of motion, and KSS scores.</p> Results <p>Knee subluxation was present in 53.3% (8/15) of patients, lateral meniscus injury in 60% (9/15), and meniscal entrapment in 40% (6/15). The mean preoperative waiting time was 5.3 days, operation time was 118&#xa0;min, and intraoperative blood loss was 300&#xa0;ml. No neurovascular injuries, skin necrosis, or deep infections occurred. One case of superficial infection resolved with wound care and antibiotics. All fractures united with a mean healing time of 13 weeks. At a mean follow-up of 18 months, the average knee extension was 3°, flexion was 122°, and the mean KSS score was 85 points (12 excellent, 2 good, and 1 fair).</p> Conclusion <p>The anterior auxiliary limited open incision is an effective treatment for Schatzker IV-TMP/PLC fractures, facilitating direct management of the articular depression and meniscal pathology, and yielding satisfactory functional outcomes.</p>

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Anterior auxiliary limited open incision for Schatzker IV total medial plateau fractures with posterolateral collapse: a retrospective study

  • 期刊论文

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  • 发表日期：

    2026年6月27日

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  • Xu-sheng Qiu,
  • Zhi-jie Lei,
  • Jiang-lin Yu,
  • Xiao-yang Qi,
  • Yi-xin Chen

摘要

Background

Schatzker type IV total medial plateau fractures with posterolateral articular surface collapse, abbreviated as Schatzker IV-TMP/PLC, present a complex surgical problem. The intact anterolateral rim obstructs conventional access to the posterolateral depression, while the frequent entrapment of the lateral meniscus adds a critical soft-tissue dimension to the challenge. This study describes and evaluates a anterior limited open incision that is designed to utilize the main fracture line as a direct corridor for addressing both the osseous and soft-tissue components of this injury.

Objective

To evaluate the efficacy and outcomes of the anterior auxiliary limited open incision in the treatment of Schatzker IV-TMP/PLC fractures.

Methods

In this retrospective study, fifteen patients with Schatzker IV-TMP/PLC fractures were treated with the anterior auxiliary limited open incision, which facilitated direct reduction of the collapsed posterolateral articular surface and any trapped lateral meniscus. Perioperative parameters including waiting time, blood loss, and operation time were recorded. Postoperative follow-up was performed to assess complications, fracture healing time, muscle strength, sensation, limb length, lower limb alignment, knee range of motion, and KSS scores.

Results

Knee subluxation was present in 53.3% (8/15) of patients, lateral meniscus injury in 60% (9/15), and meniscal entrapment in 40% (6/15). The mean preoperative waiting time was 5.3 days, operation time was 118 min, and intraoperative blood loss was 300 ml. No neurovascular injuries, skin necrosis, or deep infections occurred. One case of superficial infection resolved with wound care and antibiotics. All fractures united with a mean healing time of 13 weeks. At a mean follow-up of 18 months, the average knee extension was 3°, flexion was 122°, and the mean KSS score was 85 points (12 excellent, 2 good, and 1 fair).

Conclusion

The anterior auxiliary limited open incision is an effective treatment for Schatzker IV-TMP/PLC fractures, facilitating direct management of the articular depression and meniscal pathology, and yielding satisfactory functional outcomes.