Comparation of Gerdy’s Tubercle Osteotomy Versus Conventional Anterolateral Approach for Posterolateral Tibial Plateau Fractures: A Retrospective Cohort Study

Background The optimal reduction strategy for posterolateral tibial plateau fractures (PLFs) remains controversial due to limited visualization and fixation challenges. This study compared radiographic and functional outcomes between the anterolateral approach with Gerdy’s tubercle osteotomy (ALa-GTO) and the conventional anterolateral approach with intra-articular fracture gap or cortical window osteotomy (ALa-ICO). Methods A retrospective cohort study was conducted involving 32 patients with PLFs and articular depression ≥ 4 mm. Participants were allocated to either ALa-GTO (n = 15) or ALa-ICO (n = 17). Perioperative parameters, radiographic outcomes (articular reduction, posterior slope angle [PSA], Rasmussen radiographic score [RRS]), and functional outcomes (VAS, HSS, SF-36) were assessed with a minimum 12-month follow-up. Results The ALa-GTO group demonstrated significantly shorter operative time (105.0 ± 2.4 vs. 113.8 ± .3 minutes, p = 0.013), superior PSA maintenance at 3 months and 1 year (p < 0.01), and less articular depression at all timepoints (p < 0.05). VAS scores were significantly lower in the ALa-GTO group at midterm and final follow-up (p < 0.01). SF-36 subscales revealed better physical function and role-physical outcomes in the ALa-GTO group (p < 0.001), though HSS scores did not differ significantly (p = 0.345). All osteotomy sites healed without failure, and complication rates were comparable. Conclusion The ALa-GTO technique provides enhanced direct visualization and reduction capability, and is associated with improved early radiographic outcomes and function compared to the ALa-ICO approach. It represents a viable surgical alternative for the management of PLFs. Trial registration Not applicable.