Of them, 10 cases obtained excellent results, 17 good, 4 fair. The mean operation time was 70 min (ranged, 40 to 110 min) and the mean blood loss was 100 ml (ranged, 50 to 200 ml). Some error has occurred while processing your request. The posteromedial exposure allows direct reduction of posterior and medial fracture fragments. The reduction of collapsed fractures and implantation of artificial bone allograft were supported by T-shaped distal radius plate via the posteromedial approach. Four subjects had varus deformity, three had valgus deformity. A full thickness subcutaneous anteromedial flap can be created to allow exposure and fixation of the medial malleolus if necessary. Posterior column tibial plateau fracture stabilization has been recognized as important to maintaining a well-reduced joint line.1 Inadequate reduction or stabilization has been found to increase the risk of surgical failure.2,3 However, the importance of the posterior column, especially in posterior shear type injuries, is increasingly recognized.4,5. Methods: This series includes 10 patients (9 males and one female) with a . Highlight selected keywords in the article text. A computed tomography scan confirmed an ununited posteromedial tibial plateau fracture fragment. [Fractures of the tibial pilon. Postermedial approach is an effective method for distal tibia fractures especially accompanying with local soft tissue injury or bad skin condition. Long-term retrospective study of 51 fractures treated with open reduction and osteosynthesis]. A full thickness subcutaneous anteromedial flap can be created to allow exposure and fixation of the medial malleolus if necessary. 1998 Apr;84(2):180-8. Classically, FHL release is performed with an open approach requiring a large incision with extensive soft-tissue dissection especially around the neurovascular structures.10 We describe an endoscopic approach for release of the FHL muscle from the distal tibia with the advantage of minimal soft-tissue dissection.13 It is indicated if there is . 2009 Nov;23(11):1323-5. Dissection of the posterior tibia is facilitated from the joint line proximally to the lateral border of the tibia. 3. This approach preserves the saphenous vein and nerve, minimizes soft-tissue destruction [11] and allows for an anterolateral incision. . 2. The sloppy lateral or supine position has also been described and allows access to the anterior and anterolateral plateau while still providing access to the posterior column.7 However, if the posterior fracture line is too far posterior or lateral, reduction and stabilization from a supine position can be challenging. Open grade III "floating ankle" injuries: a report of eight cases with review of literature. The use of an elevator or osteotome to lever the 2 fragments back into position is frequently effective. This includes posteromedial, posterolateral, and posterior column shear type injuries. Publication types English Abstract MeSH terms Adult Aged Female Follow-Up Studies Fracture Fixation, Internal / methods* Humans Male Middle Aged Soft Tissue Injuries / surgery* The aim of this study was to explore the efficacy and safety of the posteromedial anatomical plate for such fractures. The operative leg is elevated with foam positioners under the knee and thigh before draping the limb. Based on the above, the following strategies for surgical approach selection were proposed: when the posterior malleolar fragment was large and affected the tarsal tunnel or the medial malleolus, a posteromedial approach was used to treat the posterior side of the distal tibia, while the anterior side of the distal tibia and fibula fractures . Abstract Background: The posterior approach to the ankle and hindfoot can be used for fixation of fractures, fusions, or osteotomies and is especially useful in patients with poor soft tissue anteriorly, medially, or laterally. The medial head of the gastrocnemius is mobilized from the posteromedial aspect of the tibia. 2009;23:4551. The posteromedial exposure allows direct reduction of posterior and medial fracture fragments. Nonlocked screws are placed distally to add to the buttress effect of the plate. Bony instability should be addressed with further reduction and stabilization, whereas soft tissue instability may be treated with repair, reconstruction, or bracing/immobilization. From August 2008 to August 2010,31 patients (21 males and 10 females, ranged in age from 24 to 68 years with an average of 46 years) with distal tibia fractures accompanying with anterior soft tissue injury were treated with open reduction and internal fixation through posteromedial approach. Posteromedial and posterolateral approaches provide good visualization of distal posterior tibia. Posteromedial Approach to Medial Malleolus, Shoulder Anterior (Deltopectoral) Approach, Shoulder Lateral (Deltoid Splitting) Approach, Shoulder Arthroscopy: Indications & Approach, Anterior (Brachialis Splitting) Approach to Humerus, Posterior Approach to the Acetabulum (Kocher-Langenbeck), Extensile (extended iliofemoral) Approach to Acetabulum, Hip Anterolateral Approach (Watson-Jones), Hip Direct Lateral Approach (Hardinge, Transgluteal), Hip Posterior Approach (Moore or Southern), Anteromedial Approach to Medial Malleolus and Ankle, Gatellier Posterolateral Approach to Ankle, Tarsus and Ankle Kocher (Lateral) Approach, Ollier's Lateral Approach to the Hindfoot, Medial approach to MTP joint of great toe, Dorsomedial Approach to MTP Joint of Great Toe, Posterior Approach to Thoracolumbar Spine, Retroperitoneal (Anterolateral) Approach to the Lumbar Spine, begin 5 cm above the medial maleollus on the posterior border of the tibia, curve incision distally following the posterior border of the medial malleolus, end incision 5cm distal to medial malleolus, should be safetly posterior to long saphenous vein and saphenous nerve, Incise retinaculum behind medial malleolus in a way that it can be repaired, retract remaining structure posteriorly (neurovascular bundle, FHL, FDL), perform subperiosteal dissection to expose posterior border of the tibia, stay on bone to avoid injury to posterior structures. The authors report no conflict of interest. The incision is deepened through the subcutaneous fat and fascia and the deep fascia is revealed over the tendons of tibialis posterior and flexor digitorum longus, the posterior tibial neurovascular bundle and the flexor hallucis longus tendon. 2002;84:15411551. Objective: official website and that any information you provide is encrypted The relative vicinity of large neurovascular structures to this incision and approach demands . Posteromedial approach and posterior plating of the tibia. Higgins TF, Kemper D, Klatt J. The patient was indicated for open reduction and internal fixation using a buttress plate. 1998. }, author={Ali Oznur and Cemalettin Aksoy and Ahmet Mazhar Tokg{\"o}zolu}, journal={The Journal of . According to typing of AO, type 43A were in 26 cases and type 43C1 were in 5 cases. Rev Chir Orthop Reparatrice Appar Mot. A precontoured buttress plate and a push-pull device are used to achieve compression with the plate. Get new journal Tables of Contents sent right to your email inbox, https://otaonline.org/video-library/45036/procedures-and-techniques/multimedia/17896815/posteromedial-, August 2020 - Volume 34 - Issue - p S33-S34, Posteromedial Approach to Tibial Plateau Fracture Nonunion, Articles in PubMed by Charlotte N. Shields, BS, Articles in Google Scholar by Charlotte N. Shields, BS, Other articles in this journal by Charlotte N. Shields, BS, Prone Posteromedial Approach for Posterior Column Tibial Plateau Fractures, Treatment Failure in Femoral Neck Fractures in Adults Less Than 50 Years of Age: Analysis of 492 Patients Repaired at 26 North American Trauma Centers, Clinical Outcomes for Hemiarthroplasty Versus Total Hip Arthroplasty in Patients With Femoral Neck Fracture Who Meet Published National Criteria for Total Hip Arthroplasty, Open Reduction and Internal Fixation of the Posteromedial Tibial Plateau via the Lobenhoffer Approach, Simplified Antibiotic-Coated Plating for Infected Nonunion, Fracture-Related Infection, and Single-Stage Prophylactic Fixation. Careers. [Effect of interlocking intramedullary nail in treatment of open tibial and fibula fractures]. 10.1097/00005373-200210000-00017 . Tibial condylar fractures. NCI CPTC Antibody Characterization Program. Anatomic reduction is then achieved and provisionally fixed using K-wires. POSTEROMEDIALAPPROACH USES This approach is used for all medial and posterior malleolar fractures. posterolateral approach . Learn more Watch on YouTube Courtesy: Matt Graves MD, University of Mississippi Medical School, USA Post Views: 7,235 El tnel del tarso es un espacio angosto osteofibroso en la regin posteromedial del tobillo de 2 a 3 cm de ancho, en donde se encuentran anatmicamente de medial a lateral el tendn del tibial posterior, el flexor largo de los dedos, la arteria tibial posterior y vena, el nervio tibial en su porcin final, as como el tendn flexor . The posteromedial supine approach to the proximal tibia provides direct visual access to the medial tibial condyl. In better quality bone, a nonlocked lag screw may be chosen. Dec 416, 2022, Revised proximal femur module is now online. A posterior plate can be placed, effectively buttressing the posterior fragments. 2002; 53(4):722-724. tibialis posterior tendon (tibial nerve) flexor digitorum (tibial nerve) Approach Position supine exsanguinate limb Incision Make 10 cm longitudinal curved incision with concavity of incision pointing anterior begin 5 cm above the medial maleollus on the posterior border of the tibia Anteromedial approach to the distal tibia Select a chapter 1. 8600 Rockville Pike The neurovascular bundle can be retracted anteromedially or posterolaterally. Dangers The structures at risk during posteromedial approach to ankle joint include: Tibialis posterior muscle. Average healing time for closed fractures was 13 weeks (ranged, 10 to 18 weeks), while open fractures was 19 weeks (ranged, 15 to 29 weeks). Restoring the mechanical axis of the knee has been found to be the most important prognostic factor in treating tibial plateau fractures.6 Coronal alignment is most commonly discussed, but recreating sagittal plane mechanical alignment is also critically important. Although it is uncommon, it can be accomplished using the principles demonstrated in this video and allows optimal visualization of the fracture while minimizing soft tissue injury. The anterolateral approach offers excellent visualization of the tibial articular surface as far as the medial malleolus, while avoiding dissection of the anteromedial tibial face. Multiple deep surgical intervals can be used dependent on the fracture configuration. The patient is intubated on the stretcher. extending from the articular surface of the posterior horn of the medial meniscus distally to the distal to tibial surface which is . Unable to load your collection due to an error, Unable to load your delegates due to an error. The treatment of distal tibial fractures with anterior soft tissue injury is relatively difficult. First described in 1997, the Lobenhoffer approach provides access to the posteromedial and posterior aspects of the proximal tibia, allowing for reduction and stabilization of fractures in this location with a posteromedial plate. Six weeks later, radiographs demonstrate maintenance of the reduction and evidence of early healing. Wolters Kluwer Health, Inc. and/or its subsidiaries. sharing sensitive information, make sure youre on a federal The neurovascular bundle can be retracted anteromedially or posterolaterally. Conclusions: The posteromedial approach and placement of a posterior plate for tibial plateau fractures results in ranges of motion that permit an appropriate function and involve mild pain. 3) Between the flexor digitorum communis and the flexor hallucis longus. Intraoperative image of the posteromedial approach at the stage of fixation of the posterior edge of the tibia with a 1/3-tubular plate: 1 1/3-tubular plate fixation the posterior fragment of the tibia; 2 posterior tibial muscle, flexor digitorum longus, retracted by the Farabeuf hook; 3 the flexor hallucis longus and the posterior neurovascular bundle, retracted by the . Journal of Orthopaedic Trauma34:S33-S34, August 2020. Tibial Plateau - Anterolateral and Posteromedial Approaches - YouTube 0:00 / 7:55 Sign in to confirm your age This video may be inappropriate for some users. The posteromedial approach to the knee is a powerful tool in the treatment of Moore type 1 tibial plateau fractures and nonunions. 6. A full thickness subcutaneous anteromedial flap can be created to allow exposure and fixation of the medial malleolus if necessary. 2010;24:683692. orif. 2. You may search for similar articles that contain these same keywords or you may Accessibility PMC Publication types Comparative Study Skin incision . This video outlines the prone posteromedial approach to the tibial plateau for posterior column fracture exposure, reduction, and fixation. This includes posteromedial, posterolateral, and posterior column shear-type injuries. Tibial plateau fractures can involve fracture planes that require reduction and stabilization from a posterior approach. A full thickness subcutaneous anteromedial flap can be created to allow exposure and fixation of the medial malleolus if necessary. Medial/posteromedial approach to the proximal tibia Select a chapter 1. . posteromedial; prone; plateau; fracture; approach. government site. The .gov means its official. A vertical posteromedial incision is made over the proximal tibia from the popliteal crease proximally to the medial border of the gastrocnemius distally. Your message has been successfully sent to your colleague. The technique is safe, effective, and allows for direct visualization and fixation. Posteromedial approach to the distal tibia See details Minimally invasive approach to the distal tibia See details Medial approach to the distal tibia See details Posterolateral limited open approach to the distal tibia See details Safe zones of the tibia See details Nailing limited open approach to the distal tibia See details J Orthop Trauma. Data is temporarily unavailable. For more information, please refer to our Privacy Policy. You may be trying to access this site from a secured browser on the server. Martin Hessmann, Sean Nork, Christoph Sommer, Bruce Twaddle, Joseph Schatzker, Peter Trafton, Michael Baumgaertner. Principles Patient positioning If the patient's hip is normal, position the patient supine, abduct and externally rotate the leg and put it in a figure of 4 position. REFERENCES 1. Indications This approach is indicated in cases of posterior comminution and/or a posterior extension of a medial malleolar fracture. One may plate posteromedial and posterolateral fragments separately. Methods: Posteromedial approach to the malleoli Select a chapter 1. bJamaica Hospital Medical Center, Queens, NY. An official website of the United States government. J Orthop Trauma. MeSH This video outlines the prone posteromedial approach to the tibial plateau for posterior column fracture exposure, reduction, and fixation. 2. However, a high rate of wound complications has been reported with standard posterolateral and posteromedial approaches. A postoperative plan includes antibiotics and venous thromboembolism prophylaxis. 4. The prone positioning allows for access to the posterior iliac crest for autogenous bone graft, which is harvested before knee fixation. The relative vicinity of large neurovascular structures to this incision and approach demands . Reduction and stabilization of these fragments can be accomplished in a variety of ways. Proximally the incision is parallel to the posteromedial border of the tibia. Luo CFF, Sun H, Zhang B, et al. Lansinger O, Bergman B, Krner L, et al. Would you like email updates of new search results? Introduction The anteromedial approach is useful in many types of fractures involving the articular surface, especially if the medial malleolus is also involved. Anterior translation of the distal fragment with posterior sag of the femur and a posterior plateau fragment is best treated with posterior reduction and buttress plate fixation. J Bone Joint Surg Am. Multiple reduction aides help facilitate anatomic alignment. All the patients were followed up from 12 to 36 months with an average of 21 months. 4). to maintaining your privacy and will not share your personal information without The posteromedial supine approach to the proximal tibia provides direct visual access to the medial tibial condyl. To investigate the clinical results of distal tibia fractures accompanying with anterior soft tissue injury by posteromedial approach. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Bethesda, MD 20894, Web Policies Please enable it to take advantage of the complete set of features! A twenty-year follow-up. 2) Between the posterior tibial tendon and the flexor digitorum communis (see illustration). Connect with peers, learn from experts. 2. Reduction of the posterior column fragment can only be performed with the knee in full extension. [Application of minimally invasive locking compression plate in treatment of distal tibia fractures]. Several towel bumps can be applied under the knee to accomplish this. J Trauma. The incision is deepened through the subcutaneous fat and fascia and the deep fascia is revealed over the tendons of tibialis posterior and flexor digitorum longus, the posterior tibial neurovascular bundle and the flexor hallucis longus tendon. Fig. Bookshelf Federal government websites often end in .gov or .mil. Knee function after longer follow-up. Complex fractures of the proximal tibia often involve a large posteromedial fragment. We present our technique for this approach for the treatment of an isolated posteromedial tibial plateau fracture. The incision is centered at the ankle joint, between the Achilles tendon and the posteromedial border of the distal tibia. Tibial plateau fractures can involve planes that require reduction and stabilization from a posterior approach. 5. Keyword Highlighting His knee range of motion is 0120 degrees. Video available at:https://otaonline.org/video-library/45036/procedures-and-techniques/multimedia/17896815/posteromedial-approach-to-tibial-plateau-fracture. This site needs JavaScript to work properly. Dec 416, 2022, Revised distal humerus module is now online. Semantic Scholar extracted view of "Posteromedial approach and posterior plating of the tibia." by A. Oznur et al. The prone approach provides access from the posteromedial to the posterolateral tibial plateau. 5 cm in the distal direction (Fig. Deep vein thrombosis prophylaxis is discontinued. Excessive distal and lateral dissection can result in injury to the posterior . The patient is strapped to the bed to allow safe bed rotation. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. {Oznur2002PosteromedialAA, title={Posteromedial approach and posterior plating of the tibia. Incision The incision is centered at the ankle joint, between the Achilles tendon and the posteromedial border of the distal tibia. Weigel DP, Marsh JL. It is a safe procedure if the correct timing is respected, usually 5-10 days after initial trauma. The interval used for deep dissection is dependent on the location of the major fracture fragments. This extension exposes both the talonavicular joint and the master knot of Henry. Excessive distal and lateral dissection can result in injury to the posterior tibial recurrent artery. During superficial dissection the knee is slightly flexed to relieve gastrocnemius tension. your express consent. Multiple deep surgical intervals can be used dependent on the fracture configuration. The https:// ensures that you are connecting to the Conclusion: High-energy fractures of the tibial plateau. Debnath UK, Maripuri SN, Guha AR, Parfitt D, Fournier C, Hariharan K. Arch Orthop Trauma Surg. The case presented is a 60-year-old man who sustained a posterior column shear type tibial plateau fracture after being struck by a motor vehicle. Reprints: Kenneth A. Egol, MD, Department of Orthopaedic Surgery NYU Langone Medical Center, 301 E 17th St, New York, NY 10003 (e-mail: [emailprotected]). The splited fractures was fixed by less invasive stabilization system (LISS) plate via the anterolateral approach. Autogenous iliac crest bone graft is applied to the nonunion site and packed into the bone gap to fill the void and aid in altering the biologic milieu at the nonunion site. Barei DP, O'Mara TJ, Taitsman LA, et al. Weil YA, Gardner MJ, Boraiah S, et al. Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. If the hip is stiff position the patient in a lateral decubitus with the involved limb down. Unimpeded knee extension is necessary to aid fracture fragment reduction. By continuing to use this website you are giving consent to cookies being used. This approach is a useful addition to a surgeon's tool kit. Background and purpose: Tibial avulsion fractures of PCL are common; however, the choice between open reduction internal fixation (ORIF) and arthroscopic repair of acute fractures remains controversial. The posteromedial exposure allows direct reduction of posterior and medial fracture fragments. Results: Introduction The posteromedial exposure allows direct reduction of posterior and medial fracture fragments. Proximally the incision is parallel to the posteromedial border of the tibia. J Orthop Trauma. 3) Between the flexor digitorum communis and the flexor hallucis longus. Posteromedial anatomical plate for the treatment of distal tibial fractures with anterior soft tissue injury. The interval used for deep dissection is dependent on the location of the major fracture fragments. 2009 Mar;23(3):268-70. This is only useful for proximal exposure as the distal posterior tibial tendon should not be dissected from the posterior tibia. Proximally the incision is parallel to the posteromedial border of the tibia. This approach preserves the saphenous vein and nerve, minimizes soft-tissue destruction and allows for an anterolateral incision. Notably execution of these approaches is technically possible and is not associated with high risk of injury to vascular-nervous bundle and other anatomic structures. This approach allows for directly buttressing the posterior fracture fragments and allows a second anteromedial incision if necessary. Cross-foot of 40 occurred in 1 case and pes valgus of 30 in 1 case at final follow-up; and AOFAS ankle scores were from 69 to 100 with an average of 88.4 +/- 9.7. 1986;68:1319. The posteromedial approach to the knee is a powerful tool in the treatment of Moore type 1 tibial plateau fractures and nonunions. Release of the posterior tibial tendon sheath is done through this approach. Distally the incision is parallel to the path of the posterior tibial tendon. Subcutaneous dissection is taken down to the gastrocnemius fascia. A posterior plate can be placed, effectively buttressing the posterior fragments. The posteromedial exposure allows direct reduction of posterior and medial fracture fragments. Clipboard, Search History, and several other advanced features are temporarily unavailable. Tibial Plateau - Anterolateral. J Orthop Trauma. This video outlines the prone posteromedial approach to the tibial plateau for posterior column fracture exposure, reduction, and fixation. It may be located: 1) Between the tibia and the posterior tibial tendon. Approach to posteromedial fragment The second plane between FDL and TP could expose the PM tibial plafond. The incision is centered at the ankle joint, between the Achilles tendon and the posteromedial border of the distal tibia. Copyright 2022 Lineage Medical, Inc. All rights reserved. Posterior bicondylar tibial plateau fractures. A posterior plate can be placed, effectively buttressing the posterior fragments. The patient was treated nonoperatively and eventually underwent knee arthroscopy for persistent pain. Varus angulation occurs in patients with bilateral tibial plateau fractures. For access to the posteromedial quadrant of the distal tibia, it is necessary to carefully incise the deep fascia proximally, protecting the neurovascular bundle. Access to articular impaction is provided through the posterior window, posterior arthrotomy at the posteromedial joint line, or longitudinally splitting the medial collateral ligament and performing an arthrotomy deep to the longitudinal split. . J Bone Joint Surg Am. The popliteus muscle belly is elevated off the posterior tibia subperiosteally to protect the popliteal neurovascular bundle from iatrogenic injury. This website uses cookies. All rights reserved. One surgical option is the posteromedial approach in the prone position. Three-column fixation for complex tibial plateau fractures. Conclusions: The latter approach places the least traction on the flap containing the neurovascular bundle. The interval between the posterior border of the gastrocnemius and the semimembranosus tendon is developed to provide access to the posteromedial proximal tibia. The posteromedial approach to ankle joint can be extended distally by curving it across the medial border of the ankle, ending over the talonavicular joint. 1. Dissection of the posterior tibia is then facilitated from the joint line proximally to the lateral border of the tibia. 2) Between the posterior tibial tendon and the flexor digitorum communis (see illustration). The visual control of fracture reduction is achieved by using a lateral standard arthrotomy to the lateral tibia plateau, as described previously. Although it is uncommon, it can be accomplished using the principles demonstrated in this video and allows optimal visualization of the fracture while minimizing soft tissue injury. This interval requires direct exposure and protection of the neurovascular bundle along its length. As such, approaches that allow access to these fragments are important to joint line reduction and stabilization. Search for Similar Articles detach posterior tibialis remove off the posterior surface of the interosseous membrane the posterior tibial artery and nerve will be posterior to posterior tibialis and FHL follow IOM to tibia follow the posterior surface of the interosseous membrane to the lateral border of the tibia release posterior tibialis and FDL of tibia This approach allows for directly buttressing the posterior fracture fragments and allows a second anteromedial incision if necessary. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. The semimembranosus tendon can be tagged if more anterior exposure is necessary. This approach allows for directly buttressing the posterior fracture fragments and allows a second anteromedial incision if necessary. Anteromedial and Posteromedial Approaches to the Distal Tibia OrthopaedicPrinciples.com Anteromedial and Posteromedial Approaches to the Distal Tibia This video is age-restricted and only available on YouTube. The interval between injury and operation was 7-14 days (mean, 9 days). It may be located: 1) Between the tibia and the posterior tibial tendon. Accurate reduction of this fragment onto the tibial shaft is critical t. FOIA Care should be taken to avoid injury to the small saphenous vein and saphenous nerve. Please enable scripts and reload this page. After reduction, the knee should be examined through a range of motion and varus/valgus stresses. 2011 Jun 14;34(6):161. doi: 10.3928/01477447-20110427-15. 2008;22:176182. Please try after some time. HHS Vulnerability Disclosure, Help For access to the posteromedial quadrant of the distal tibia, it is necessary to carefully incise the deep fascia proximally, protecting the neurovascular bundle. 2009. Before 2. Rev Chir Orthop Reparatrice Appar Mot. This is only useful for proximal exposure as the distal posterior tibial tendon should not be dissected from the posterior tibia. Disclaimer, National Library of Medicine Skip to search form Skip to main . 2023 Bobby Menges Memorial HSS Limb Reconstruction Course. Epub 2007 Apr 5. Wolters Kluwer Health This interval requires direct exposure and protection of the neurovascular bundle along its length. Access to the tibia is through a separate plane which is developed on the posteromedial border of the peroneal muscles. Hong J, Zeng R, Lin D, Guo L, Kang L, Ding Z, Xiao J. Orthopedics. It is well suited for an accurate articular reduction, as well as submuscular and subcutaneous plate applications spanning metaphyseal comminution. volkman's fragment. Conclusion: Postermedial approach is an effective method for distal tibia fractures especially accompanying with local soft tissue injury or bad skin condition. Incidence and morphology of the posteromedial fragment in bicondylar tibial plateau fractures. A posterior plate can be placed, effectively buttressing the posterior fragments. 4). The location of arthrotomy, if required, is dependent on where the fracture line exits the tibial plateau. After the tendon sheaths were incised in line with its underlying tendon, the FDL was retracted laterally to protect the NV bundle, while the TP tendon was mobilized and subluxated medially over the medial malleolus. Of the 31 cases, 14 cases were open fractures (including 5 cases Gustilo-Anderson type I, 5 type II, 2 type III A, and 2 type III B) and 17 cases were closed fractures (including 3 cases Tcherne-Oestern type I, 12 type II, 2 type III). Please try again soon. A nonsterile tourniquet is applied to the thigh before prone positioning on well-padded chest rolls, on a radiolucent flattop table. ADVANTAGES This approach can easily be extended proximally or distally. Shields, Charlotte N. BSa; Eftekhary, Nima MDa; Egol, Kenneth A. MDa,b, aNYU Langone Orthopaedic Hospital, NYU Langone Medical Center, New York, NY; and. 2005;19:7378. Incision Start the incision 1 cm distal and 1 cm anterior to the middle of the tip of the medial malleolus. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007 Oct;127(8):625-31. doi: 10.1007/s00402-007-0314-y. may email you for journal alerts and information, but is committed At that time, he had a fracture nonunion. modify the keyword list to augment your search. Long toe flexor releases can be done easily through the upper portion of this approach. Operation time, intraoperative blood loss, fracture healing time, AOFAS ankle score, and complications were recorded to evaluate clinical effects. Posteromedial approach to the distal tibia Posteromedial approach to the distal tibia Select a chapter 1. Connect with peers, learn from experts. Exposure of the posterior aspect of the tibia is achieved by developing the interval between the peroneal tendons and muscles laterally and the flexor hallucis longus (FHL) medially. Carlson DA. Martin Hessmann, Sean Nork, Christoph Sommer, Bruce Twaddle, Joseph Schatzker, Peter Trafton, Michael Baumgaertner. These are now retracted laterally. and transmitted securely. Screws are drilled using standard techniques. With a raspatory, soft tissue can be removed from fragments, which can be exposed in an L-shaped area at the dorsal side of the lateral tibial plateau (Fig. At the first postoperative visit, he is placed in an unlocked hinged knee brace. The patient presented with knee pain and a feeling of instability. Physical examination revealed no observable anterior to posterior drawer, but there was an increase in varus laxity. Posteromedial supine. A posterior plate can be placed, effectively buttressing the posterior fragments. This surgical technique video demonstrates a dual posteromedial portal arthroscopic approach to repair an unstable medial meniscal ramp lesion using a case example from a patient with a concomitant ACL rupture. 7. The medial collateral ligament is located anteriorly and should be protected. He was referred 7 months after initial injury. He will remain nonweight-bearing for 3 months. posteromedial approach. The site is secure. Exposure of the posterior tibial malleolus was greater with the modified posteromedial approach (91%) compared with the other 2 approaches (posteromedial = 64%, posterolateral = 40%). We assessed the efficacy and safety of managing PCL avulsion fractures with ORIF using the posteromedial approach. Distally the incision is parallel to the path of the posterior tibial tendon. Based on bone quality, bone loss, and the potential for over compression, the decision was made to use a locked screw proximally. 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