Proximal Tibial Intra-articular Osteotomy for Treatment of Complex Schatzker Type IV Tibial Plateau Fractures With Lateral Joint Line Impaction

This study presents a retrospective review of 8 patients with 9 cases of an uncommon variant of medial tibial plateau fracture treated with a surgical approach not previously described in the literature. The fracture pattern is characterized by a displaced medial tibial plateau fracture with significant central and posterior impaction of the lateral tibial articular surface but an intact lateral cortex. A novel surgical approach with an intra-articular osteotomy of the lateral tibial plateau was used to facilitate visualization, reduction, and instrumentation of the lateral articular injury. Early clinical and radiographic results of this treatment approach were reviewed. We describe the fracture pattern, surgical technique, and early results and propose this technique as a reasonable alternative for treatment of a challenging clinical entity.