Lobbenhaufer approach to treat tibial plateau fracture: How and Why?

Introduction: Tibial plateau fractures involving the posterior column are complex and often underdiagnosed without advanced imaging. Proper identification and surgical planning are essential for optimal outcomes. The Lobenhoffer approach, described in 2003, provides direct access to the posteromedial tibial plateau and facilitates stable fixation. 

Case Presentation: We report the case of a 57-year-old male involved in a motorcycle accident who sustained a split-depression fracture of the lateral tibial plateau with an associated, initially missed, posteromedial fragment identified on CT. Emergency management included closed reduction and external fixation. After soft tissue recovery, definitive fixation was performed in two stages: first, a prone posteromedial approach according to Lobenhoffer was used to reduce and stabilize the posteromedial fragment with a T-plate in antiglide configuration. Second, the patient was positioned supine for lateral plateau fixation via a standard anterolateral approach. Postoperative imaging showed good fracture reduction. Recovery was uncomplicated with protected weight-bearing and progressive rehabilitation. 

Discussion: The posteromedial approach enables safe access to posterior tibial plateau fractures without crossing the popliteal fossa, minimizing neurovascular risk. Literature supports its biomechanical and clinical advantages in achieving stable fixation and good functional outcomes. 

Conclusion: The Lobenhoffer approach is a reliable and minimally invasive option for managing posteromedial tibial plateau fractures, allowing for direct visualization, accurate reduction, and secure fixation.