Posterolateral Approach for Plating of Tibial Plateau Fractures and the Risk of Injury to the Anterior Tibial Vessels

2013 ◽  
Vol 27 (9) ◽  
pp. e228-e229 ◽  
Author(s):  
Wen-Tao Chen ◽  
Ying-Qi Zhang ◽  
Shi-Min Chang
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Posterolateral Approach ◽  
Risk Of Injury ◽  
Anterior Tibial

scholarly journals The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

2020 ◽  
Vol 46 (6) ◽  
pp. 1211-1219 ◽  
Author(s):  
Karl-Heinz Frosch ◽  
Alexander Korthaus ◽  
Darius Thiesen ◽  
Jannik Frings ◽  
Matthias Krause
Keyword(s):  
Prone Position ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Lateral Meniscus ◽  
Tibial Plateau Fractures ◽  
Posterolateral Approach ◽  
Central Segment ◽  
Anatomic Reduction ◽  
Lateral Plating ◽  
Lateral Plateau

AbstractMalreduction after tibial plateau fractures mainly occurs due to insufficient visualization of the articular surface. In 85% of all C-type fractures an involvement of the posterolateral-central segment is observed, which is the main region of malreduction. The choice of the approach is determined (1) by the articular area which needs to be visualized and (2) the positioning of the fixation material. For simple lateral plateau fractures without involvement of the posterolateral-central segment an anterolateral standard approach in supine position with a lateral plating is the treatment of choice in most cases. For complex fractures the surgeon has to consider, that the articular surface of the lateral plateau only can be completely visualized by extended approaches in supine, lateral and prone position. Anterolateral and lateral plating can also be performed in supine, lateral and prone position. A direct fixation of the posterolateral-central segment by a plate or a screw from posterior can be only achieved in prone or lateral position, not supine. The posterolateral approach includes the use of two windows for direct visualization of the fracture. If visualization is insufficient the approach can be extended by lateral epicondylar osteotomy which allows exposure of at least 83% of the lateral articular surface. Additional central subluxation of the lateral meniscus allows to expose almost 100% of the articular surface. The concept of stepwise extension of the approach is helpful and should be individually performed as needed to achieve anatomic reduction and stable fixation of tibial plateau fractures.

Open Reduction and Internal Fixation of Posterolateral Tibial Plateau Fractures Through Fibula Osteotomy–Free Posterolateral Approach

2014 ◽  
Vol 28 (9) ◽  
pp. 513-517 ◽  
Author(s):  
Hong-Wei Chen ◽  
Guo-Dong Liu ◽  
Shan Ou ◽  
Gang-Sheng Zhao ◽  
Jun Pan ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Posterolateral Approach

Anterior Tibial Artery and Its Clinical Importance in the Posterolateral Approach to the Tibial Plateau: An Angiographic Study on 219 Lower Limbs

2020 ◽  
Author(s):  
Hasan May ◽  
Ozlem Kastan ◽  
Tuluhan Yunus Emre ◽  
Mustafa Cetin ◽  
Melih Unal ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Popliteal Artery ◽  
Tibial Plateau ◽  
Joint Line ◽  
Interosseous Membrane ◽  
Posterolateral Approach ◽  
Anterior Tibial Artery ◽  
Branching Pattern ◽  
Fibular Head ◽  
Anterior Tibial

AbstractThe anterior tibial artery (ATA) is the most critical anatomical structure at risk at the distal border of the posterolateral approach to the tibial plateau. This study aimed to use available lower extremity digital subtraction angiography (DSA) images to determine the distal safe limit of this approach by measuring the distance from the tibial joint line to the ATA where it pierces the interosseous membrane. Tibial plateau mediolateral width (TP-ML-W) and the perpendicular distances from the ATA to the tibial joint line and fibular head were measured on DSA images in 219 lower extremities. To normalize the distances according to the tibial dimensions, each distance was divided by the TP-ML-W, and a ratio was obtained. Popliteal artery branching pattern was categorized according to the classification proposed by Kim et al. Comparative analysis between right and left extremities, genders, and anatomical variations were performed. There were 102 male and 26 female subjects with a mean age of 60.7 ± 15.7 years (range, 17–92 years). Ninety-one subjects had bilateral lower extremity DSA; thus, a total of 219 extremities were analyzed. The TP-ML-W was wider in male (78.3 ± 7.0) than female (70.5 ± 7.3) subjects (p = 0.001). The ATA coursed through the interosseous membrane at 50.9 ± 6.9 mm (range, 37.4–70.2 mm) distal to the tibial plateau joint line, and it was 66.5 ± 7.2% of the TP-ML-W. The ATA coursed through the interosseous membrane at 36.5 ± 6.0 mm (range, 21.9–53.8 mm) distal to the fibular head, and it was 47.7 ± 6.6% of the TP-ML-W. All measured variables were similar between the regular branching pattern of the popliteal artery (type 1A) and other observed variations among male subjects. The safe length of dissection in the posterolateral approach is average 66.5% (range, 45.7–86.7%) of the TP-ML-W. This ratio is valid for both genders. The use of a ratio instead of a distance, which is subject to personal variations, seems to be more logical and practical for planning this surgery, but the wide range should still not be ignored.

A New Posterolateral Approach Without Fibula Osteotomy for the Treatment of Tibial Plateau Fractures

2010 ◽  
Vol 24 (8) ◽  
pp. 515-520 ◽  
Author(s):  
Karl-Heinz Frosch ◽  
Peter Balcarek ◽  
Tim Walde ◽  
Klaus Michael Stürmer
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Posterolateral Approach

A Novel Method of the Treatment for Posterolateral Tibial Plateau Fractures

2019 ◽  
Vol 33 (10) ◽  
pp. 1010-1019
Author(s):  
Dong Ren ◽  
Yueju Liu ◽  
Yanxi Chen ◽  
Jian Lu ◽  
Zhaohui Song ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Vertical Displacement ◽  
Knee Extension ◽  
Tibial Plateau Fractures ◽  
Posterolateral Approach ◽  
Anterolateral Approach ◽  
Plateau Fracture

AbstractReduction and fixation of posterolateral tibial plateau fracture via a posterolateral approach is challenging, and the posterolateral approach itself may injure the posterolateral ligament complex of the knee and can result in knee instability. We developed a new curved support plate (CSP) that can pass, via traditional anterolateral approach, through the superior tibiofibular interval and effectively support the posterolateral fragments. The purpose of our study was to determine the biomechanical reliability of the new plate and report the preliminary efficacy of the CSP for posterolateral tibial plateau fracture. In the biomechanical experiment, 40 synthetic tibias were used to create posterolateral shearing tibial fracture models, which were randomly assigned to groups A to D. Vertical displacement of the posterolateral fragments was measured under axial loads of 500 to 1,500 N. The new plate and 3.5-mm lateral locking plate exhibited similar control over fragment displacement. From June 2016 to August 2017, eight patients with posterolateral tibial plateau fracture underwent treatment with the CSP. Hospital for Special Surgery (HSS) knee score, knee flexion and extension ranges of motion, and complications were recorded to evaluate treatment effects. Eight patients (five men and three women, mean age 44 years [range, 23–66 years]) were enrolled in the study. Mean follow-up time was 13 months (range, 7–19 months). All patients achieved radiographic bone union by 3.3 months (range, 3–4 months) postoperatively. There were no complications of neurovascular injury, deep vein thrombosis, infection, and implant loosening throughout the follow-up period. At final follow-up, mean HSS score was 92.6 (88–96), with a mean knee flexion of 131.25 degrees (120–135 degrees) and a mean knee extension of 1 degree (0–5 degrees). Fixation of posterolateral tibial plateau fracture was easily and successfully achieved using our newly designed CSP, which may provide a new choice for posterolateral tibial plateau fractures.

The Risk of Injury to the Anterior Tibial Artery in the Posterolateral Approach to the Tibia Plateau

2013 ◽  
Vol 27 (4) ◽  
pp. 221-225 ◽  
Author(s):  
Nima Heidari ◽  
Surjit Lidder ◽  
Wolfgang Grechenig ◽  
Norbert P. Tesch ◽  
Annelie M. Weinberg
Keyword(s):  
Posterolateral Approach ◽  
Anterior Tibial Artery ◽  
Tibial Artery ◽  
Risk Of Injury ◽  
Anterior Tibial ◽  
Tibia Plateau
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