Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture

  • Hui Sun
  • Cong-Feng Luo
  • Guang Yang
  • Hui-Peng Shi
  • Bing-Fang Zeng
Original Article

Abstract

Objective

The study was undertaken to evaluate the efficacy and safety of a posterolateral reversed L-shaped knee joint incision for treating the posterolateral tibial plateau fracture.

Methods

Knee specimens from eight fresh, frozen adult corpses were dissected bilaterally using a posterolateral reversed L-shaped approach. During the dissection, the exposure range was observed, and important parameters of anatomical structure were measured, including the parameters of common peroneal nerve (CPN) to ameliorate the incision and the distances between bifurcation of main vessels and the tibial articular surface to clear risk awareness.

Results

The posterolateral aspect of the tibial plateau from the proximal tibiofibular joint to the tibial insertion of the posterior cruciate ligament was exposed completely. There was no additional damage to other vital structures and no evidence of fibular osteotomy or posterolateral corner complex injury. The mean length of the exposed CPN was 56.48 mm. The CPN sloped at a mean angle of 14.7° toward the axis of the fibula. It surrounded the neck of the fibula an average of 42.18 mm from the joint line. The mean distance between the opening of the interosseous membrane and the joint line was 48.78 mm. The divergence of the fibular artery from the posterior tibial artery was on average 76.46 mm from articular surface.

Conclusions

This study confirmed that posterolateral reversed L-shaped approach could meet the requirements of anatomical reduction and buttress fixation for posterolateral tibial plateau fracture. Exposure of the CPN can be minimized or even avoided by modifying the skin incision. Care is needed to dissect distally and deep through the approach as vital vascular bifurcations are concentrated in this region. Placement of a posterior buttressing plate carries a high vascular risk when the plate is implanted beneath these vessels.

Keywords

Tibial plateau fracture Posterolateral Surgical approach Anatomy 

References

  1. 1.
    Kennedy JC, Bailey WH (1968) Experimental tibial-plateau fractures. Studies of the mechanism and a classification. J Bone Joint Surg Am 50:1522–1534PubMedGoogle Scholar
  2. 2.
    Bhattacharyya T, McCarty LP 3rd, Harris MB, Morrison SM, Wixted JJ, Vrahas MS, Smith RM (2005) The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma 19:305–310PubMedCrossRefGoogle Scholar
  3. 3.
    Waldrop JI, Macey TI, Trettin JC, Bourgeois WR, Hughston JC (1988) Fractures of the posterolateral tibial plateau. Am J Sports Med 16:492–498PubMedCrossRefGoogle Scholar
  4. 4.
    Luo CF, Sun H, Zhang B, Zeng BF (2010) Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 24:683–692PubMedCrossRefGoogle Scholar
  5. 5.
    Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zeng BF (2012) Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee 19:94–98PubMedCrossRefGoogle Scholar
  6. 6.
    Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscheme H (1997) Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg 100:957–967PubMedCrossRefGoogle Scholar
  7. 7.
    Carlson DA (2005) Posterior bicondylar tibial plateau fractures. J Orthop Trauma 19:73–78PubMedCrossRefGoogle Scholar
  8. 8.
    Egol KA (2005) Split depression posterolateral tibial plateau fracture: direct open reduction and internal fixation. Tech Knee Surg 4:257CrossRefGoogle Scholar
  9. 9.
    Tao J, Hang DH, Wang QG, Gao W, Zhu LB, Wu XF, Gao KD (2008) The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee 15:473–479PubMedCrossRefGoogle Scholar
  10. 10.
    Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, Yu GR (2009) Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg 129:955–962PubMedCrossRefGoogle Scholar
  11. 11.
    Solomon LB, Stevenson AW, Baird RP, Pohl AP (2010) Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationale. J Orthop Trauma 24:505–514PubMedCrossRefGoogle Scholar
  12. 12.
    Frosch KH, Balcarek P, Walde T, Sturmer KM (2010) A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma 24:515–520PubMedCrossRefGoogle Scholar
  13. 13.
    Schatzker J (1987) Fractures of the tibial plateau. In: Schatzker J, Tile M (eds) The rationale of operative fracture care. Springer, Berlin, pp 279–295CrossRefGoogle Scholar
  14. 14.
    Gossling HR, Peterson CA (1979) A new surgical approach in the treatment of depressed lateral condylar fractures of the tibia. Clin Orthop Relat Res 140:96–102PubMedGoogle Scholar
  15. 15.
    Carlson DA (1998) Bicondylar fracture of the posterior aspect of the tibial plateau. A case report and a modified operative approach. J Bone Joint Surg Am 80:1049–1052PubMedGoogle Scholar
  16. 16.
    Minkoff J, Jaffe L, Menendez L (1987) Limited posterolateral surgical approach to the knee for excision of osteoid osteoma. Clin Orthop Relat Res 223:237–246PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Hui Sun
    • 1
  • Cong-Feng Luo
    • 1
  • Guang Yang
    • 1
  • Hui-Peng Shi
    • 1
  • Bing-Fang Zeng
    • 1
  1. 1.Department of Orthopaedic Surgery, Shanghai Sixth People’s HospitalShanghai Jiaotong UniversityShanghaiChina

Personalised recommendations