[The posterocentral approach to the posterior tibial plateau]

Abstract

Objective: An anatomically preformed approach to the posterior tibial plateau is described. In avulsion fractures of the posterior cruciate ligament (PCL), the aim is to restore stability of the knee joint with functional treatment, while in posterior shearing tibial plateau fractures the aim is to restore anatomical dorsal alignment of the tibia.

Indications: Avulsion fracture the PCL, posterior shearing tibial plateau fracture.

Contraindications: Knee infection, compartment syndrome, joint instability, and osteoarthritis in avulsion fractures of the PCL.

Operation technique: Supine position, L-shaped skin incision, dissection of the fascia, protection of the sural nerve, separation of the gastrocnemial heads, identification of the neurovascular bundle, retraction of the gastrocnemial heads. Fixation of the bony avulsion using screws. In tibial plateau fractures, dissection of the soleus and popliteus muscle, fracture reduction, and plate fixation.

Postoperative management: Due to the approach no specific treatment necessary. PCL: functional treatment, with knee brace full weight bearing possible, without 20 kg weight bearing using crutches for 4-6 weeks, tibia: CT for postoperative result and planning of the ventral osteosynthesis after about 5 days, then weight bearing 20 kg and functional treatment for 8-12 weeks.

Results: A total of 33 patients were operated using a posterocentral approach, 22 had a posterior shearing tibial plateau fracture, and 11 an avulsion fracture of the PCL. Temporary hypesthesia around the scar, at the lateral foot, and lateral lower leg were observed in 3 patients, each having one (area supplied by the sural nerve). In 3 cases screw tips at the anterior proximal tibia were palpable. The posterocentral approach reveals a low complication rate due to the anatomical approach.