Abstract
Purpose
To evaluate the distances between the incision and neurovascular structures in direct posterior split-gastrocnemius approach for tibial plateau fractures.
Methods
Thirteen fresh-frozen cadavers were used in the study. The distance between the neurovascular structures medial and lateral to the incision was measured from the tibial joint line and at a level 5 cm distal to the joint line.
Results
The mean distance between the incision and medial neurovascular structures was 10.09 ± 3.47 mm (range 5.63–16.51 mm) at the level of the tibial joint line and 10.39 ± 2.57 mm (range 5.79–14.09 mm) at a level 5 cm distal to the joint line. The mean distance between the incision and the common peroneal nerve was 13.44 ± 4.17 mm (range 6.28–20.72 mm) at the level of the tibial joint line and 19.56 ± 5.24 mm (range 12.58–26.74 mm) at a level 5 cm distal to the joint line.
Conclusions
In isolated posterolateral tibial plateau fractures, it is possible to apply anatomical reduction and buttress plating on the posterior surface with a direct posterior split-gastrocnemius approach. With a thorough understanding of the regional anatomy, this approach can be safely performed by experienced orthopaedists.
Similar content being viewed by others
References
Frosch KH, Balcarek P, Walde T, Stürmer KM. A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma. 2010;24(8):515–20. doi:10.1097/BOT.0b013e3181e5e17d.
Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zend BF. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee. 2012;19(2):94–8.
Lobenhoffer P, Gerich T, Bertram T, Latterman C, Pohlemann T, Tscherne H. Particular postero-lateral approaches for treatment of tibial head fractures. Unfallchirurg. 1997;100:957–67.
Solomon LB, Stevenson AW, Baird RP, Pohl AP. Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationals. J Orthop Trauma. 2010;24:505–14.
Bhattacharyya T, McCarty LP III, Harris MB, Morrison S, Wixted JJ, Vrahas MS, et al. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma. 2005;19(5):305–10.
Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma. 2005;19:73–8.
Tao J, Hang DH, Wang QG, Gao W, Zhu LB, Wu XF, et al. The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee. 2008;15:473–9.
Yu GR, Xia J, Zhou JQ, Yang YF. Low-energy fracture of posterolateral tibia plateau: treatment by a posterolateral prone approach. J Trauma Acute Care Surg. 2012;72(5):1416–23.
Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res. 1979;138:94–104.
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and Dislocation Classification Compendium—2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee. J Orthop Trauma. 2007;21(10 Suppl):S1–163.
Lowe JA, Tejwani N, Yoo B, Wolinsky P. Surgical techniques for complex proximal tibial fractures. J Bone Jt Surg Am. 2011;93(16):1548–59.
Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010;24(11):683–92. doi:10.1097/BOT.0b013e3181d436f.
Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, et al. 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. 2009;129:955–62.
Ozdemir G, Yilmaz B, Oztermeli A. Open reduction and internal fixation of the isolated tibial lateral plateau posterior fracture using direct posterior split gastrocnemius approach. Case Rep Surg. 2015. doi:10.1155/2015/530578.
Sun H, Luo CF, Yang G, Shi HP, Zeng BF. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol. 2013;23(7):809–18. doi:10.1007/s00590-012-1067-z.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Güzelali Özdemir, Barış Yılmaz, Turgut Akgül, Serdar Yılmaz, Özgür Çiçekli and Abdulkadir Dost declare that they have no conflict of interest.
Ethical standards
In this article, there was no conflict with ethical standards of the Committee on Publication Ethics guidelines. No benefits or funds were received in support of this study.
Rights and permissions
About this article
Cite this article
Özdemir, G., Yilmaz, B., Şirin, E. et al. The anatomical relationship of the neurovascular structures in direct posterior lateral gastrocnemius split approach for posterolateral tibial plateau fractures. Eur J Trauma Emerg Surg 44, 427–432 (2018). https://doi.org/10.1007/s00068-017-0790-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-017-0790-x