Anterolateral Approach for Reduction of Tibial Pilon Fractures The anterolateral approach ( Fig. 2.1 Anterolateral approach Lateral tibial plateau fractures are very common. Plating on the lateral surface of tibial plafond is a new entity and the anterolateral approach is gaining popularity for the fixation of tibial pilon fractures. Lateral tibial plateau fractures are very common. This incision is centered at the ankle joint, parallel to the fourth metatarsal distally, and parallel to and between the tibia and fibula proximally. Posteromedial Reversed L-shaped Approach for Posterior Column Tibial Pla... Feat. If this approach is used in a staged fashion, when the soft envelope is ready, it affords excellent visualization for fracture fixation through thick skin flaps. Many fractures of the tibial plateau can be treated with an anterolateral approach to the proximal tibia. Their results could be improved by following the new guidelines for the management, and modern plating techniques. It was worth noting that the sufficient length of the minimum distance of 7cm between the incisions was applied, which avoid ischemic necrosis of the skin bridge and wound complications. Courses, webinars, and online events, in your region or worldwide, Pediatric distal femur module is now online. Open the deep fascia anterior to the ilio-tibial tract. anterolateral epiphyseal fracture that is similar to the lateral tibial avulsion fractures observed in cadavers by the late French sur-geon Paul Jules Tillaux in 1892. A valgus defor-mity, swelling and tenderness in the right knee were found on physical examination. This nerve invariably crosses the surgical incision proximal to the ankle joint. Radiographs including the foot, ankle, tibia, and knee should be obtained. The anterolateral approach to the distal tibial plafond fracture is indicated for fracture with anterior and/or lateral comminution and/or impaction. ANATOMY Internal rotation of distal tibia 4. The fascia over the anterior compartment of the distal tibia is incised sharply, beneath the superficial peroneal nerve. OBJECTIVE: The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. 10 anatomy and PatHoPHysiology The distal tibial physis con-tributes 50% of tibial growth and approximately 0.25 inches (4-6 mm) of longitudinal growth per year.11,12 Proximally, the dissection is limited by the origin of the anterior compartment muscles from the fibula and from the interosseous membrane. However, access to the medial ankle joint is poor, and proximal extension is limited. Application of a distractor intraoperatively greatly assists with articular visualization. Close the remaining soft tissues in a routine manner. Mechanism Typically high energy injuries and occur as a result of an axial loading which. In contrast, an anterolateral approach to the tibial plafond allows direct access to the Tillauxe Chaput fragment, but provides suboptimal access to the medial side [18, 19]. The anterolateral approach to the tibia has been popularized for management of tibial pilon fractures. Clinically, isolated PL quadrant tibial plateau fractures were treated via an anterolateral supra-fibular-head approach and lateral rafting plate fixation. As is the case with tibial plateau fractures, these injuries occur close to the joint and must be treated with the cartilage surface of the ankle joint in mind. Materials and Methods: This retrospective and prospective study analyzes the This portion of the fracture is cleansed and the entrapped periosteum is excised. Anterolateral Approach for Tibial Pilon Fractures David J. Hak, MD, MBA H igh-energy tibial pilon fractures present signifi - cant challenges. The anterolateral approach to the tibia has been popularized for management of tibial pilon fractures. 2008;22:299–305. The posterolateral approach is an extremely useful exposure to access and manipulate the posterior aspect of the tibial plafond.17, 18 It is most useful for those B-type tibial pilon fractures where the unstable articular segment is located posteriorly and has no significant articular comminution. For distal tibial fractures, Bohler's anterolateral approach allows better visualization of the distal tibial joint surface and fixation of the tibia and fibula with a single distal anterolateral incision 13, 14. This approach is the anterolateral approach to deal with a tibial plateau fracture (Schatzker III) in detail. It is well suited for an accurate articular reduction, as well as submuscular and subcutaneous plate applications spanning metaphyseal comminution. Full-length images of the tibia and fibula complete the radiological examination of the injured leg. The anterolateral approach is indicated for pilon fractures that involve the lateral column. 1–4). To expose the joint make a horizontal capsulotomy between the deep edge of the meniscus and the tibia. Opening the fascia. Dissection through the skin and subcutaneous tissues should proceed sharply with maintenance of full thickness skin flaps. Even with proper treatment, there can be both short and long-term complications of ankle joint function. These muscles and tendons are usually easy to mobilize from the underlying anterior tibiofibular ligament, the periosteum of the distal tibia, and the joint capsule. J Orthop Trauma. The approach was characterized by direct handling PM and PL fragments of posterior tibial plafond through three different anatomic planes in supine position. Often this presents with a failure into valgus on injury films. Ch. was managed surgically through a combined angiosome- or perforator-sparing anterolateral approach Figure 1. We present a case of 69 year-old female with a isolated joint-depression fracture of the lateral tibial plateau. Anteromedial Approach. A second 4 mm Schanz pin is placed from lateral to medial at the tibia, proximal to the anticipated plate application. Contraindications include anteromedial or medial exit of the primary fracture line and primarily medial defects and/or comminution. Case Presentation A 66-year-old woman had sustained a car crush injury 3 h prior to her presentation to our hospital. 2015 Nov;7(4):368-70. doi: 10.1111/os.12205. DEFINITION Distal tibia fractures are primarily located within a square based on the width of the distal tibial metaphysis. The transverse branch of the incision is almost in line with the medial incision for talus neck fracture [ 23 ], while the vertical branch is medial to the Achilles tendon and extends proximally based on metaphyseal involvement. Make a straight incision lateral to the patella. Plating on the lateral surface of tibial plafond is a new entity and the anterolateral approach is gaining popularity for … Between 2010 and 2011, ten patients with posterolateral tibial plateau fracture were treated using an extended anterolateral approach with a proximal tibial locking compression plate. These are considered to represent 1-10% of all lower limb fractures 6. Imaging. Skin incision. The epidemiological data, operation details, and clinical outcomes over 26.4 ± 2.3 months (range 24–30 months) of follow-up were prospectively collected and analyzed. This video illustrates the indications, surgical approach, case examples and outcomes from pilon fixation through an anterolateral approach. Plating on the lateral surface of tibial plafond is a new entity and the anterolateral approach is gaining popularity for the fixation of tibial pilon For complex fracture patterns a combined anterolateral/anteromedial approach is suitable but a high rate of complication has been reported. The outcome of the patients was assessed after a short to medium follow-up period. Anterolateral Approach Because most tibial plateau fractures involve thelateral tibial plateau, an anterolateral approach is the most frequently used approach for the treatment of plateau fractures ( Figs. We retrospectively reviewed 28 ankles with AO/OTA type C pilon fractures that were treated using the anterolateral approach combined with medial MIPO. Conclusion: Anterolateral plating in the distal end tibial fractures using the anterolateral approach is safe, easy, and effective and has fair the functional outcome with less complication. Since the anterior compartment muscles arise from the anterior fibula, the incision is usually not extended more than seven centimeters above the ankle joint. After submeniscus arthrotomy, the comminuted lateral plateau is … An osteotomy anterolateral approach for lateral tibial plateau fractures merged with relatively simple and intact posterolateral corner displacement De-peng Meng , # 1 Tian-wen Ye , # 1 and Ai-min Chen 1 the anterolateral approach to deal with a tibial plateau fracture (Schatzker III) in detail. A 4 mm Schanz pin is placed transversely from lateral to medial at the talar neck through the surgical incision. The approach was characterized by direct handling PM and PL fragments of posterior tibial plafond through three different anatomic planes in supine position. The diagnosis of a displaced fracture of the tibial plafond is made on these radiographs. Keyword: Osteosynthesis, Anterolateral Approach, Distal Tibia References 1.Canale ST, Beaty JH. The purpose of this study was to compare the efficacy of anterolateral distal tibial locking plates in capturing main fracture fragments in tibial plafond fractures. approach difficulty is encountered in visualization of the Chaput fragment [10, 11]. A prospective study evaluating incision placement and wound healing for tibial plafond fractures. The patient was managed surgically through a combined angiosome- or perforator-sparing anterolateral approach and a posteromedial approach on day 2 postinjury. 2. It may be indicated in anterior and anterolateral AO Type B fractures, in AO Type C fractures with articular damage laterally, and in those cases with a valgus deformity thus requiring a lateral buttress plate. This surgical incision can be used Close the ilio-tibial band and if necessary reattach the Gerdy’s tubercle. The anterolateral approach to the tibia has been popularized for management of tibial pilon fractures. Tibial plafond fractures are one of the most challenging injuries in orthopaedic surgery. DOI: 10.1097/BOT.0b013e3181e5e17d Corpus ID: 205491525 A New Posterolateral Approach Without Fibula Osteotomy for the Treatment of Tibial Plateau Fractures @article{Frosch2010ANP, title={A New Posterolateral Approach Without Fibula Osteotomy for the Treatment of Tibial Plateau Fractures}, author={Karl-Heinz Frosch and P. Balcarek and T. Walde and K. … Often there is significant soft tissue injury with a tibial plafond fracture. Materials and Methods: This retrospective and prospective study analyzes the functional outcome of Anterolateral distal tibia LCP for treatment of distal tibia fracture. Additionally, the distractor helps to align several of the major articular fragments. This video reviews the indications, surgical approach, and case examples of the anterolateral approach to a distal tibial plafond fracture. We present our technique for this approach with special focus on performing a submeniscal arthrotomy, placing a femoral distractor and elevation of the joint surface. However, the incision requires Advantages also include good soft tissue cover, ability to get to both tibia and fibula and if there is an open wound on the medial side. Treatment of AO/OTA Type C Pilon Fractures Through the Anterolateral Approach Combined With the Medial MIPO Technique Gi Beom Kim, MD , Oog-Jin Shon, MD , and Chul Hyun Park, MD Foot & Ankle International 2018 39 : 4 , 426-432 Which of the following nerves is MOST at risk during an anterolateral incision and exposure of … Positioning. Supine position was set up and a pad was put under the affected hip. The transverse branch of the incision is almost in line with the medial incision for talus neck fracture [ 23 ], while the vertical branch is medial to the Achilles tendon and extends proximally based on metaphyseal involvement. 9.1. 2.1 Anterolateral approach. - small anterolateral approach - joint reduction and cannulated screw from Tillaux fragment medially - medial percutaneous plate . Take care not to damage the superficial peroneal nerve which lies directly beneath the skin. Place small bump under the ipsilateral hip and torso. Campbell's Operative Orthopaedics. The anterolateral approach is the mostly used to treat tibial plateau fractures in the clinic. Footnote: (a) An illustration in the mid-sagittal plane is demonstrating the involved anterior joint capsule (circle) with associated osteophytes from the anterior tibial plafond and anterior talar neck. Illustration shows a partial articular distal tibia fracture. Initial anteroposterior (AP), mortise, and lateral radiographs are obtained. It should be identified, mobilized, and protected throughout the surgical procedure. Fractures of the foot, tibial shaft, or fibula should be evaluated. Open the deep fascia anterior to the ilio-tibial tract.