9.1. Approach to Osteochondral Lesions of the Tibial Plafond. This incision is centered at the ankle joint, parallel to the fourth metatarsal distally, and parallel to and between the tibia and fibula proximally. the anterolateral approach to deal with a tibial plateau fracture (Schatzker III) in detail. Close the ilio-tibial band and if necessary reattach the Gerdy’s tubercle. Place small bump under the ipsilateral hip and torso. 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. Even with proper treatment, there can be both short and long-term complications of ankle joint function. The anteromedial approach is used for OTA 43B and C fractures and allows access for medial and anterior hardware placement especially when the posterolateral (Volkman) is the constant fragment. These are considered to represent 1-10% of all lower limb fractures 6. This approach is typically utilized for split-depression lateral plateau (Schatzker type II) and bicondylar (Schatzker type VI, type V) fracture patterns. The fascia of the extensor digitorum brevis can be incised, with the muscle carefully dissected and retracted medially. The patient was managed surgically through a combined angiosome- or perforator-sparing anterolateral approach and a posteromedial approach on day 2 postinjury. The anterolateral approach to the tibia has been popularized for management of tibial pilon fractures. Example 2 . 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 2008;22:299–305. Illustration shows a partial articular distal tibia fracture. We retrospectively reviewed 28 ankles with AO/OTA type C pilon fractures that were treated using the anterolateral approach combined with medial MIPO. After submeniscus arthrotomy, the comminuted lateral plateau is … 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. If this approach is used in a staged fashion, when the soft envelope is ready, it affords excellent visualization for … Additionally, the distractor helps to align several of the major articular fragments. Positioning. 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. Anterolateral Approach for Tibial Pilon Fractures David J. Hak, MD, MBA H igh-energy tibial pilon fractures present signifi - cant challenges. Since the anterior compartment muscles arise from the anterior fibula, the incision is usually not extended more than seven centimeters above the ankle joint. Keyword: Osteosynthesis, Anterolateral Approach, Distal Tibia References 1.Canale ST, Beaty JH. 2015 Nov;7(4):368-70. doi: 10.1111/os.12205. J Orthop Trauma. A tibial plateau fracture in a 40-year-old male with extensive florid psoriasis. Joseph Schatzker, Ernst Raaymakers, Rick Buckley. A tibial plafond fracture (also called a tibial pilon fracture) occurs at the end of the shin bone and involves the ankle joint. 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. EPIDEMIOLOGY Avg. 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. Their results could be improved by following the new guidelines for the management, and modern plating techniques. 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. Mean age was 46 years (range, 19 to 75), and the mean follow-up period was 25 months (range, 14 to 50). Dissection through the skin and subcutaneous tissues should proceed sharply with maintenance of full thickness skin flaps. Caution Do not attempt to expose the postero-medial side of the tibia from the antero-lateral approach. For selected cases, with a significant compromise of the posterolateral and anterolateral quadrants of the tibial plateau, including the tibial spines, the extended anterolateral approach may be complemented by a planned detachment of the anterior horn of the lateral meniscus. 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. 2. Due to this reason, the anterolateral approach is the most frequently used surgical approach for tibial plateau fractures. Close the remaining soft tissues in a routine manner. Tibial plafond fractures are one of the most challenging injuries in orthopaedic surgery. Case Presentation A 66-year-old woman had sustained a car crush injury 3 h prior to her presentation to our hospital. Tibial plafond fractures occur just above the ankle joint and involve that critical cartilage surface of the ankle. The affected hip scan or magnetic resonance imaging ( MRI ) [ 2, 6 ] the meniscus and is... Perforator-Sparing anterolateral approach to deal with a tibial plateau fracture in a significant rate wound... 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