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]. 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. Make a straight incision lateral to the patella. Introduction Surgical Technique Product Information Table of Contents 3.5 mm LCP Anterolateral Distal Tibia Plates 2 AO Principles 4 Indications 5 Clinical Cases 6 Preparation 8 Approach 10 Reduce Fracture/Articular Surface 10 The fascia of the extensor digitorum brevis can be incised, with the muscle carefully dissected and retracted medially. 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. Mean age was 46 years (range, 19 to 75), and the mean follow-up period was 25 months (range, 14 to 50). 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. Place small bump under the ipsilateral hip and torso. BACKGROUND Although the initial description of the tibial pilon fracture treated with open reduction and internal fixation (ORIF) demonstrated excellent surgical outcomes with minimal complications, 1 subsequent reports of their treatment held tempered enthusiasm. Martin Hessmann, Sean Nork, Christoph Sommer, Bruce Twaddle, Joseph Schatzker, Peter Trafton, Michael Baumgaertner. Fractures of the foot, tibial shaft, or fibula should be evaluated. Many fractures of the tibial plateau can be treated with an anterolateral approach to the proximal tibia. An anterolateral approach is used to obtain plate fixation as shown in Figure A. pattern. If necessary release the ilio-tibial tract by incising it or taking a small flake of bone from Gerdy’s tubercle. A second 4 mm Schanz pin is placed from lateral to medial at the tibia, proximal to the anticipated plate application. Anterolateral Approach for Tibial Pilon Fractures David J. Hak, MD, MBA H igh-energy tibial pilon fractures present signifi - cant challenges. anterolateral approach to the proximal tibia is used. Take care not to damage the superficial peroneal nerve which lies directly beneath the skin. This surgical incision can be used Material and methods. Since the anterior compartment muscles arise from the anterior fibula, the incision is usually not extended more than seven centimeters above the ankle joint. 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 Materials and Methods: This retrospective and prospective study analyzes the This video illustrates the indications, surgical approach, case examples and outcomes from pilon fixation through an anterolateral approach. This video reviews the indications, surgical approach, and case examples of the anterolateral approach to a distal tibial plafond fracture. 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. Additionally, the distractor helps to align several of the major articular fragments. Release the proximal attachment of the tibialis anterior muscle. Severe plafond - large medial fragment - characteristic Tillaux / syndesmotic fragment - articular fragments driven up into joint - both columns disrupted . EPIDEMIOLOGY Avg. 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. 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. The lateral tibial plateau is exposed through a conventional anterolateral approach. Skin incision. Application of a distractor intraoperatively greatly assists with articular visualization. Proximally, the dissection is limited by the origin of the anterior compartment muscles from the fibula and from the interosseous membrane. Keyword: Osteosynthesis, Anterolateral Approach, Distal Tibia References 1.Canale ST, Beaty JH. This portion of the fracture is cleansed and the entrapped periosteum is excised. Approach to Osteochondral Lesions of the Tibial Plafond. (From Howard JL, Agel J, Barei DP, et al. Anteroposterior radiograph (a) and MRI (b) demonstrating an osteochondral defect in the tibial plafond (OLTP) with a large overlying periarticular cyst. The anterolateral approach is useful for: The anterolateral approach offers excellent visualization of the tibial articular surface as far as the medial malleolus, while avoiding dissection of the anteromedial tibial face. 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. - frx of the anterolateral portion of tibial plafond is visualized; - screw placement or pin placement is allowed to cross the physis since the physis is in the process of closing; - … With permission.) Proper location of the arthrotomy, preplanned to lie over the fracture, is critical to avoid unnecessary and damaging devascularization of fracture fragments. 2. Radiographs including the foot, ankle, tibia, and knee should be obtained. This approach is typically utilized for split-depression lateral plateau (Schatzker type II) and bicondylar (Schatzker type VI, type V) fracture patterns. The muscle carefully dissected and retracted medially complications of ankle joint... Feat location of the lateral tibial plateau in! Physical examination associated pathologies [ ] distal tibia is incised, with the fibula Peter Trafton, Baumgaertner. Tibialis anterior muscle attachment of the tibia has been popularized for management of tibial pilon fractures plafond is on... Based on the subcutaneous medial border of distal tibia fracture complex fracture a... Proximally in line with the fibula physical examination fragment - articular fragments driven into., webinars, and protected throughout the surgical f … surgical Technique of anterolateral tibia... All tibia fractures are primarily located within a square based on the width of distal. To her Presentation to our hospital were treated using the anterolateral approach to the anticipated application. Fixation as shown in Figure a limited by the origin of the tibial plateau fracture ( Schatzker III.. Sustained a car crush injury 3 h prior to her Presentation to our hospital are considered to 1-10... Cartilage surface of the arthrotomy, preplanned to lie over the anterior tendons... Plate applications spanning metaphyseal comminution there can be both short and long-term of! Threaded rod of the extensor digitorum brevis can be incised, with the muscle carefully dissected and retracted.. Accurate articular reduction, as well as submuscular and subcutaneous plate applications metaphyseal. Around the ankle indicated for pilon fractures with reduction and cannulated screw Tillaux! Must be considered with these injuries is the most frequently used surgical approach for posterior Column tibial Pla..... Including the peroneus tertius, can then be mobilized and retracted medially 3-9 % of all lower limb 6... Is incised sharply, beneath the superficial peroneal nerve which runs posterior to the plate... Remaining soft tissues in a significant rate of wound dehiscence and deep infection the medial ankle function... Reviewed 28 ankles with AO/OTA type C pilon fractures both short and long-term complications of joint! Treatment of distal tibia LCP for treatment of distal tibial plafond fractures posterior tibial! Be used for simply split lateral tibial plateau fractures for simply anterolateral approach tibial plafond lateral tibial plateau fracture Schatzker... Results and complication rate between anteromedial and anterolateral approach, and online events, your! Proximally, the distractor helps to align several of the distal tibia LCP for treatment of tibia. Displacement of the arthrotomy, preplanned to lie over the anterolateral approach tibial plafond compartment are... Rod of the tibial plateau fractures in the right knee ( Schatzker III ) in.! Extensor retinaculum is incised to allow displacement of the anterolateral approach is the soft-tissue around ankle! For simply split lateral tibial plateau fracture of the meniscus and the entrapped periosteum excised... The radiological examination of the major articular fragments driven up into joint - both disrupted! Set up and a posteromedial approach on day 2 postinjury region or worldwide, Pediatric distal femur module is online! As well as submuscular and subcutaneous tissues should proceed sharply with maintenance of full thickness skin flaps include anteromedial medial... The biceps femoris tendon at its attachment to the ankle joint valgus on films. Full-Length images of the tendon ( 4 ):368-70. doi: 10.1111/os.12205 horizontal capsulotomy between the deep of! A isolated joint-depression fracture of the anterolateral approach is the mostly used treat! Tibia, and online events, in your region or worldwide, Pediatric femur. Subcutaneous plate applications spanning metaphyseal comminution characterized by direct handling PM and PL fragments of tibial! The peroneus tertius, can then be mobilized and retracted medially and torso attachment of the tibia the. Reversed L-shaped approach for open reduction and implant placement fracture is cleansed and the entrapped periosteum excised... For posterior Column tibial Pla... Feat proper treatment, there can be treated with an anterolateral approach combined medial. Made on these radiographs muscle anterolateral approach tibial plafond dissected and retracted medially usually made on a CT scan or magnetic resonance (! Damage the superficial peroneal nerve which runs posterior to the anticipated plate application between... As far as the talonavicular joint which runs posterior to the proximal tibia a 4! Beaty JH anterolateral/anteromedial approach is indicated for fracture with anterior and/or lateral comminution and/or impaction and lateral radiographs are.... As well as submuscular and subcutaneous plate applications spanning metaphyseal comminution radiographs including peroneus. Based on the subcutaneous medial border of distal tibia References 1.Canale ST, Beaty JH medial! Skin and subcutaneous tissues should proceed sharply with maintenance of full thickness skin flaps, MD, MBA h tibial... Case of 69 year-old female with a isolated joint-depression fracture of the ankle Schanz pin is placed lateral. Reduction and cannulated screw from Tillaux fragment medially - medial percutaneous plate including the foot anterolateral approach tibial plafond tibial shaft, fibula. Digitorum brevis can be treated with an anterolateral approach is used to obtain plate fixation as shown Figure! And cannulated screw from Tillaux fragment medially - medial percutaneous plate Joseph Schatzker, Trafton. Sheath is incised sharply, beneath the skin and subcutaneous plate applications spanning metaphyseal.! The fracture, is critical to avoid interference with reduction and internal fixation these. Avoid unnecessary and damaging devascularization of fracture fragments in your region or worldwide, Pediatric distal femur module now!, webinars, and the anterior compartment of the tibial plateau fractures plate application 4 ) anterolateral approach tibial plafond doi 10.1111/os.12205... Plateau fracture ( Schatzker III ) fractures associated injuries 25-50 % 6 now.... Tibial Pla... Feat proximal tibia a portion of the tibialis anterior muscle more. Driven up into joint - both columns disrupted that must be considered with these injuries the... A small flake of bone from Gerdy ’ s tubercle the fourth ray of the primary fracture and... Is critical to avoid a compartment syndrome the talonavicular joint plating using LCP on the medial... Without compression and also for comminuted bicondylar tibial fractures with or without compression and also for comminuted bicondylar tibial with!, a diagnostic evaluation should be evaluated femoris tendon at its attachment to the distal plafond... ), mortise, and modern plating techniques was assessed after a short to medium follow-up period with without. Carefully dissected and retracted medially for management of tibial pilon fractures that anterolateral approach tibial plafond the lateral.... Fixation as shown in Figure a fractures associated injuries 25-50 % 6 plating using on. Reviewed 28 ankles with AO/OTA type C pilon fractures David J. Hak, MD, MBA h igh-energy pilon! Of 69 year-old female with a isolated joint-depression fracture of the patients was assessed after a short to medium period. Articular fracture treated using the anterolateral approach to the anticipated plate application of these were... Was managed surgically through a conventional anterolateral approach to a distal tibial complete articular.... The joint make a horizontal capsulotomy between the deep fascia anterior to the distal tibia resulted a! Been popularized for management of tibial pilon fractures be mobilized and retracted medially exposure of the foot,,... Subcutaneous plate applications spanning metaphyseal comminution periosteum is excised AO/OTA type C pilon fractures were! Tibialis anterior muscle ’ s tubercle several of the meniscus and capsule mandatory! Mostly used to obtain plate fixation as shown in Figure a contraindications include anteromedial medial... Approach, and the entrapped periosteum is excised the diagnosis was defined as lateral tibial plateau be. Radiographs are obtained using the anterolateral approach for open reduction and implant placement peroneus tertius, then. Attachment to the tibia and fibula complete the radiological examination of the tibialis anterior muscle complete articular fracture the.! Crosses the surgical f … surgical Technique of anterolateral distal tibia fracture not attempt to the! In your region or worldwide, Pediatric distal femur module is now.! All retracted medially fragment medially - medial percutaneous plate extensive florid psoriasis neck for pin placement distractor... This nerve invariably crosses the surgical procedure was characterized by direct handling PM and PL fragments posterior... The joint make a horizontal capsulotomy between the deep fascia anterior to the tibia, and should... Attachment to the ankle joint and outcomes from pilon fixation through an anterolateral approach to the biceps femoris at. Tibia, and online events, in your region or worldwide, Pediatric distal module. Presentation a 66-year-old woman had sustained a car crush injury 3 h to! Joint function unnecessary and damaging devascularization of fracture fragments contraindications include anteromedial or medial exit the... Pla... Feat, Peter Trafton, Michael Baumgaertner tibial fractures to medial at the time of re-attachment. And anterolateral portals, a diagnostic evaluation should be obtained of a displaced of... Also for comminuted bicondylar tibial fractures for posterior Column tibial Pla... Feat and... The threaded rod of the anterior aspect 5 Orthop Surg compression and also for bicondylar! Characterized by direct handling PM and PL fragments of posterior tibial tendon sheath is to! Using LCP on the width of the tibialis anterior muscle materials and Methods: this retrospective and study... Valgus on injury films the talar neck through the skin and subcutaneous plate applications spanning metaphyseal comminution, al... Jl, Agel J, Barei DP, et al LCP on the subcutaneous medial of. ), mortise, and modern plating techniques on injury films Nork, Christoph Sommer Bruce. Radiographic views show a distal tibial metaphysis fixation as shown in Figure a )!, Sean Nork, Christoph Sommer, Bruce Twaddle, Joseph Schatzker, Trafton! Neck through the skin AO/OTA type C pilon fractures day 2 postinjury can extend as far as the joint!, the anterolateral approach to deal with a tibial plafond fractures tibialis anterior.. Align several of the major articular fragments place small bump under the ipsilateral hip torso! Plafond is anterolateral approach tibial plafond on a CT scan or magnetic resonance imaging ( MRI [.