J Knee Surg 2016; 29(01): 021-027
DOI: 10.1055/s-0035-1564597
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Limited Added Value of the Posterolateral Approach

Sarah N. Pierrie
1   Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
,
Luke S. Harmer
2   Quincy Medical Group, Quincy, Illinois
,
Madhav A. Karunakar
1   Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
,
Marc R. Angerame
1   Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
,
Erica B. Andrews
3   School of Medicine, University of North Carolina, Chapel Hill, North Carolina
,
Katherine M. Sample
3   School of Medicine, University of North Carolina, Chapel Hill, North Carolina
,
Joseph R. Hsu
1   Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
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Weitere Informationen

Publikationsverlauf

03. Juli 2015

08. August 2015

Publikationsdatum:
09. November 2015 (online)

Abstract

Background Posterolateral tibial plateau fractures (AO/OTA 41-B or 41-C) represent a minority of proximal tibia fractures. Numerous surgical approaches have been described, each with unique variations and limitations. The purpose of this study is to quantitatively and qualitatively compare the surface area and structures exposed by four surgical approaches to the posterolateral proximal tibia.

Methods Four published surgical approaches—direct posterolateral (DPL), transfibular (TF), posteromedial (PM), and anterolateral (AL)—were performed on 10 fresh-frozen cadavers. Once each exposure was obtained, a ruler was placed in the surgical field and calibrated digital images obtained. Overall, 10 bony and soft tissue landmarks were identified and the surgeon's ability to see or touch each landmark was recorded sequentially for each exposure.

Results An average of 3.9 ± 2.7 cm2 of posterolateral proximal tibial cortex was exposed by the DPL approach with significantly more surface area exposed by the TF, PM, and AL approaches (p < 0.01). The AL and PM approaches revealed a significantly larger area of tibial metaphysis and, when used together, consistently exposed posterior metaphyseal and intra-articular structures.

Conclusion A combination of the AL and PM approaches allows comparable surgical exposure to the proximal tibial when compared with two posterolateral approaches. These approaches can be employed together for reduction and fixation of injuries to the posterolateral tibial plateau and allow direct evaluation of the articular surface. Dedicated posterolateral approaches should be reserved for certain clinical situations, including proximal tibiofibular joint fracture or dislocation.

 
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