Abstract
Introduction
Posterolateral tibial plateau fractures account for 7 % of all proximal tibial fractures. Their fixation often requires posterolateral buttress plating. Approaches for the posterolateral corner are not extensile beyond the perforation of the anterior tibial artery through the interosseous membrane. This study aims to provide accurate data about the inferior limit of dissection by providing measurements of the anterior tibial artery from the lateral joint line as it pierces the interosseous membrane.
Materials and Methods
Forty unpaired adult lower limbs cadavers were used. The posterolateral approach to the proximal tibia was performed as described by Frosch et al. Perpendicular measurements were made from the posterior limit of the articular surface of the lateral tibial plateau and fibula head to the perforation of the anterior tibial artery through the interosseous membrane.
Results
The anterior tibial artery coursed through the interosseous membrane at 46.3 +/− 9.0 mm (range 27–62 mm) distal to the lateral tibial plateau and 35.7 +/− 9.0 mm (range 17–50 mm) distal to the fibula head. There was no significant difference between right or left sided knees.
Discussion
This cadaveric study demonstrates the safe zone (min 27 mm, mean 45mm) up to which distal exposure can be performed for fracture manipulation and safe application of a buttress plate for displaced posterorlateral tibial plateau fractures. Evidence demonstrates quality of reduction correlates with clinical outcome and the surgeon can expect to be able to use a small fragment buttress plate of up to 45mm as this is the mean.
