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Use of horizontal rafting plates for posterior elements of complex tibial plateau fractures: description and case reports.

The standard treatment of complex tibial plateau fractures involves restoration of the articular surface, bone grafting, and stabilization with plates, screws, and k-wires. When examining the configuration of many old and newer plate designs, one can note that the screw placement may not correspond to the region of the articular surface that needs support. Furthermore, in posterolateral or posteromedial fractures, there is little ability for standard plates to provide adequate support of posterior structures when placed from the front or side. Even with locked screws, front-to-back screws are mechanically disadvantaged with cantilever loading. Posterior plating can be difficult and there are further difficulties if removal is required for any reason, e.g. knee arthroplasty or infection. In this report, we describe a method of plate placement in which standard approaches can be used to provide some support of posterior fragments, as well as provide more options for the support of articular segments. We used this method primarily to support articular fragments of bone in the posterior lateral and posterior medial aspects. We illustrate the technique and present a few case illustrations.