Anatomical Study Of Modified Posteromedial Approach And Posterolateral Approach For Posterolateral Tibial Plateau Fractures

Objective The characteristics and limitations of modified posterior medial approach and posterior lateral approach in the treatment of posterior lateral tibial condyle fracture were studied by cadaver simulated surgical approach.Methods Four adult cadavers,including three males and one female,were selected.There was no deformity of the knee joint,no skin damage,no history of surgery,and no vascular and nerve damage.Specimens can be divided into two groups,each line with left lower limbs specimens respectively modified inside inverted "L" into the road(group A,n = 4),the posterolateral incision straight into the road(group B,n = 4),after observing pretibial artery to the lateral platform and the distance of the fibular head,knee lateral artery to the distance of the posterolateral platform,knee lateral distance to pretibial artery,fibular head condition of posterolateral platform,and improved the medial road and posterolateral approach of the posterolateral tibia platform show case,analysis the advantage of two kinds of surgical approach and its limitations.Results 1.The modified posterior medial approach has the following advantages: 1.1 pulling apart the anterior tibial artery can fix the distal fracture of the posterolateral platform,which is conducive to the extension of the incision.1.2 good exposure and direct reduction can be achieved for coronal plane shear fractures of the posterolateral platform,and the placement and fixation of steel plates have more mechanical advantages.1.3 posterior medial inverted l-shaped incision is used to open the medial head of the gastrocnemius muscle and expose the popliteal vessels and soft tissue more fully.If the injuries of popliteal vessels and posterior cruciate ligament are combined,the injuries can be repaired.1.4 two fractures can be treated at the same time by the modified posterior medial approach when combined with posterior medial plateau fracture.2.The improved posterior medial approach has the following disadvantages: 2.1 the anatomical structure is complex,which requires high requirements of the surgeon.2.2 transection of the gastrocnemius muscle may pose a risk of pronation of the horseshoe.3.The posterolateral approach ha s the following advantages: small area of soft tissue dissection,less damage,and relatively simple approach.4.The posterolateral approach has the following disadvantages: 4.1 there is a risk of injury to the common peroneal nerve,which needs to be fully exposed and protected.4.2 the distance from the anterior tibial artery across the interosseous membrane to the posterolateral platform was 3.5-5.7cm,with an average of 4.36±0.7cm,2.5-4.7 cm from the fibula head,with an average of 3.4±0.8cm,affecting the longitudinal extension of the incision.4.3 The posterolateral approach usually requires ligation of the inferolateral genicular artery,which is 1.5-2.4 cm above the fibular head,with an average of 1.92±0.33 cm.The distance between the inferior lateral genicular artery and the anterior tibial artery was 4.8-6.8cm,averaging5.88±0.73 cm.The distance between the two arteries was the safe operation space of the posterolateral approach.4.4 The area of the posterolateral platform covered by the fibula head was(58.4±0.48)%,the exposure of the posterolateral platform is affected.4.5 the posterolateral complex of the knee joint,including popliteal tendons and ligaments,should be destroyed,affecting the stability of the knee joint.Conclusion Anatomical study showed that the modified posteromedial approach was more suitable for the treatment of posterolateral tibial plateau fractures than the posterolateral approach.