Skip to main content
SpringerLink
Log in

Posterozentraler Zugang zum dorsalen Tibiakopf

Rekonstruktion dorsaler Tibiakopffrakturen und Avulsionen des hinteren Kreuzbandes

Posterocentral approach to the posterior tibial plateau

Reconstruction of tibial plateau fractures and avulsions of the posterior cruciate ligament

  • Originalien
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Zur operativen Versorgung dorsal dislozierter Tibiakopffrakturen und Avulsionen des hinteren Kreuzbandes (HKB) nutzen wir den posterozentralen Zugang ohne die Ablösung oder die muskuläre Spaltung der Gastrocnemiusköpfe. Ziel der Studie war es diesen Zugang zu evaluieren.

Patienten und Methoden

Von 2001–2012 wurde an 33 Patienten der posterozentrale Zugang zum dorsalen Kniegelenk durchgeführt. 22 Patienten hatten eine Tibiakopffraktur, 11 eine Avulsion des HKB. Frakturtyp, Komplikationen, Erfahrung des Operateurs, Ausheilung, Implantatlage und -irritationen, Nervenläsionen, Sensibilitätsstörungen, Narbe und Bewegungsausmaß wurden erfasst.

Ergebnisse

Je 1 Patient wies Parästhesien im Narbenbereich, am distalen lateralen Fußrand und am dorsolateralen Unterschenkel auf. Trotz zweier ventraler Platteninfekte fand sich kein Infekt des dorsalen Implantats. Alle Narben waren reizlos, Narbenkontrakturen nicht vorhanden. In 3 Fällen waren an der Tibiavorderkante Schraubenspitzen tastbar, ohne dass dies die Patienten störte.

Schlussfolgerung

Der posterozentrale Zugang ist ein komplikationsarmer Zugang in der Hand des erfahrenen Operateurs. Die gute Weichteilbedeckung scheint Infekte zu verhindern.

Abstract

Background

For surgical treatment of posterior shearing tibial plateau fractures and avulsion fractures of the posterior cruciate ligament (PCL) a posterocentral approach without dissection or separation of the heads of the gastrocnemius muscle is used. The aim of this study was an evaluation of this approach.

Patients and methods

From 2001-2012 a total of 33 patients were surgically treated using a posterocentral approach to the dorsal knee joint. Of these patients 22 had a posterior shearing tibial plateau fracture and 11 had an avulsion fracture of the PCL. The fracture type, complications, expertise of the surgeon, fracture healing, implant position and irritation, nerve lesions, scar tissue and range of motion were documented.

Results

Hypesthesia around the scar, at the lateral foot and lower lateral leg were observed in one each of three patients. Despite two ventral implant infections no infection of the dorsal implant occurred. All scar tissue was without pathological findings and scar contracture was not observed. In three cases the screw tips at the anterior proximal tibia were palpable but without complaints from the patients.

Conclusions

The posterocentral approach showed a low complication rate in the hands of experienced surgeons. The soft tissue cover seems to prevent implant infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Abbott LC, Carpenter WF (1945) Surgical approaches to the knee joint. J Bone Joint Surg 27:277–310

    Google Scholar 

  2. Alpert JM, McCarty LP, Bach BR Jr (2008) The posterolateral corner of the knee: anatomic dissection and surgical approach. J Knee Surg 21:50–54

    Article  PubMed  Google Scholar 

  3. Baker CL, Nonvood LA, Hughston JC (1984) Acute combined posterior cruciate and posterolateral instability of the knee. Am J Sports Med 12:204–208

    Article  PubMed  Google Scholar 

  4. Benirschke SK, Agnew SG, Mayo KA et al (1992) Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol. J Orthop Trauma 6:78–86

    CAS  PubMed  Google Scholar 

  5. Berg EE (1995) Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 11:69–76

    Article  CAS  PubMed  Google Scholar 

  6. Bhattacharyya T, McCarty LP, Harris MB et al (2005) The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma 19:305–310

    Article  PubMed  Google Scholar 

  7. Bianchi M (1983) Acute tears of the posterior cruciate ligament. Clinical study and results of operative treatment in 27 cases. Am J Sports Med 11:308–314

    Article  CAS  PubMed  Google Scholar 

  8. Burks RT, Schaffer JJ (1990) A simplified approach to the tibial attachment of the posterior critiate ligament. Clin Orthop 254:216–219

    PubMed  Google Scholar 

  9. 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 80:1049–1052

    CAS  PubMed  Google Scholar 

  10. Carlson DA (2005) Posterior bicondylar tibial plateau fractures. J Orthop Trauma 19:73–78

    Article  PubMed  Google Scholar 

  11. Chang SM, Zheng HP, Li HF et al (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 129:955–962

    Article  PubMed  Google Scholar 

  12. Chin KR, Barr SJ, Winalski C et al (2002) Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am 84:2192–2202

    PubMed  Google Scholar 

  13. De Boeck H, Opdecam P (1995) Posteromedial tibial plateau fractures. Operative treatment by posterior approach. Clin Orthop Relat Res 320:125–128

    Google Scholar 

  14. Fakler JMK, Ryzewicz M, Hartshorn C et al (2007) Optimizing the management of Moore type I postero-medial split fracture dislocations of the tibial head: description of the Lobenhoffer approach. J Orthop Trauma 24:330–336

    Article  Google Scholar 

  15. Frosch KH, Proksch N, Preiss A, Giannakos A (2012) Versorgung knöcherner hinterer Kreuzbandausrisse über einen minimal-invasiven dorsalen Zugang. Oper Orthop Traumatol 24:348–353

    Article  Google Scholar 

  16. Galla M, Lobenhoffer P (2003) Der direkte dorsale Zugangsweg zur Versorgung posteromedialer Luxationsfrakturen des Tibiakopfs. Unfallchirurg 106:241–247

    Article  CAS  PubMed  Google Scholar 

  17. Galla M, Riemer C, Lobenhoffer P (2009) Die Osteosynthese posteromedialer Tibiakopffrakturen über einen direkten dorsalen Zugang. Oper Orthop Traumatol 21:51–64

    Article  PubMed  Google Scholar 

  18. Georgiadis GM (1994) Combined anterior and posterior approaches for complex tibial plateau fractures. J Bone Joint Surg Br 76:285–289

    CAS  PubMed  Google Scholar 

  19. McMaster WC (1975) Isolated posterior cruciate ligament injury: literature review and case reports. J Trauma 15:1025–1029

    Article  CAS  PubMed  Google Scholar 

  20. Meyers MH (1975) Isolated avulsion of the tibial attachment of the posterior cruciate ligament of the knee. J Bone Joint Surg Am 57:669–672

    CAS  PubMed  Google Scholar 

  21. Müller ME, Allgöwer M, Schneider R, Willenegger H (1992) Manual der Osteosynthese. AO-Technik. Springer, Berlin Heidelberg

  22. Ross AC, Chesterman PJ (1986) Isolated avulsion of the tibial attachment of the posterior cruciate ligament in childhood. J Bone Joint Surg Br 68:747

    CAS  PubMed  Google Scholar 

  23. Salter RB, Simmonds DF, Malcom BW et al (1980) The biological effect of continious passive motion on the healing of full-thickness defects in articular cartilage: an experimental investigation in the rabbit. J Bone Joint Surg Am 62:1232–1251

    CAS  PubMed  Google Scholar 

  24. Strand T, Molster AD, Engesaeter LB (1984) Primary repair in posterior cruciate injuries. Acta Orthop Scand 55:545–547

    Article  CAS  PubMed  Google Scholar 

  25. Tao J, Hang DH, Wang QG et al (2008) The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee 15:473–479

    Article  PubMed  Google Scholar 

  26. Tonin M, Saciri V, Veselko M (2001) Arthroskopische Wiederherstellung einer Ausrissfraktur des hinteren Kreuzbandes am Tibiaansatz. Unfallchirurg 104:1183–1185

    Article  CAS  PubMed  Google Scholar 

  27. Trickey EL (1968) Rupture of the posterior cruciate ligament of the knee. J Bone Joint Surg Br 50:334–341

    CAS  PubMed  Google Scholar 

  28. Veselko M, Saciri V (2003) Posterior approach for arthroscopic reduction and antegrade fixation of avulsion fracture of the posterior cruciate ligament from the tibia with cannulated screw and washer. Arthroscopy 19:916–921

    Article  PubMed  Google Scholar 

  29. Wagner H, Jakob RP (1986) Zur Problematik der Plattenosteosynthese bei den bikondylären Tibiakopffrakturen. Unfallheilkunde 89:304–307

    CAS  Google Scholar 

  30. Young MJ, Barrack RL (1994) Complications of internal fixation of tibial plateau fractures. Orthop Rev 23:149–154

    CAS  PubMed  Google Scholar 

  31. Zhao J, He Y, Wang J (2006) Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament with hsutre fixation technique through Y-shaped bone tunnels. Arthroscopy 22:172–181

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, Westpfalz-Klinikum, Kaiserslautern, Akademisches Lehrkrankenhaus der Medizinischen Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg und Johannes-Gutenberg-Universität Mainz, Hellmut-Hartert-Straße 1, 67655, Kaiserslautern, Deutschland

    M. Muhm, P. Schneider, T. Ruffing & H. Winkler

Authors
  1. M. Muhm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Ruffing
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Winkler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Muhm.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muhm, M., Schneider, P., Ruffing, T. et al. Posterozentraler Zugang zum dorsalen Tibiakopf. Unfallchirurg 117, 813–821 (2014). https://doi.org/10.1007/s00113-013-2418-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-013-2418-x

Schlüsselwörter

Keywords

Search

Navigation