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Extended medial approach in posteromedial proximal tibia fracture dislocation

Y P Acklin, Primoz Potocnik & C Sommer

abstract

OBJECTIVE
Treatment of posteromedial proximal tibia fracture dislocation (medial Moore type II, Schatzker IV) with a one-incision technique.

INDICATIONS
Posteromedial proximal tibia fracture dislocation Moore type II (medial).

CONTRAINDICATIONS
All Moore type V fracture patterns requiring a bilateral approach.

SURGICAL TECHNIQUE
In supine position, an extended strictly medial incision is performed. It is mandatory to preserve the medial collateral ligament and the pes anserinus. In a first step, the posterolateral impressed zone is reduced directly through the main fracture gap using an image intensifier. The posteromedial main fragment is then reduced and preliminarily fixed with Kirschner wires. A posteromedial buttress plate slid in under the medial ligamentous structures supports this fragment. Anterior subcutaneous dissection revolves the medial boarder of the patellar ligament and a medial arthrotomy is performed. The bony avulsed anterior cruciate ligament (ACL) is reduced and suture fixation follows.

POSTOPERATIVE MANAGEMENT
Immediate partial weight bearing is possible.

RESULTS
A collective of 26 patients could be evaluated after a median follow-up of 4 years (1-8 years). Median age was 51 years (20-77 years). All fractures healed without secondary displacement or infection. After a median of 4 years, 25 patients showed no to moderate osteoarthritis. One patient showed severe osteoarthritis after 8 years. All patients subjectively judged the clinical result as good to excellent. The average Lysholm score was 95 (75-100) and the average Tegner activity score 5 (3-7).
   
citation Acklin Y P, Potocnik P, Sommer C. Extended medial approach in posteromedial proximal tibia fracture dislocation. Oper Orthop Traumatol 2014; 27:183-90.
   
type journal paper/review (English)
date of publishing 15-11-2014
journal title Oper Orthop Traumatol (27/2)
ISSN electronic 1439-0981
pages 183-90
PubMed 25395051
DOI 10.1007/s00064-014-0306-3