Posterior malleolar fractures are present in up to 44% of all ankle fractures. Those involving > 25% of the articular surface have a higher rate of posterior ankle instability which may predispose to post traumatic arthritis. The posterolateral approach to the distal tibia allows direct reduction and stabilization of the posterior malleolus and concomitant lateral malleolus fractures. An anatomical study was performed to establish the safe zone of proximal dissection to avoid injury to the peroneal vessels in this uncommon approach. 26 unpaired adult lower limbs were dissected using the posterolateral approach to the distal tibia as described by Tornetta et al. The peroneal artery was identified coursing through the intraosseous membrane on deep dissestion as the flexor hallucis longus muscle was reflected medially. The level of its bifurcation was also noted over the tibia. Perpendicular measurements were made from the tibial plafond to these variable anatomical locations.Introduction
Methods
Percutaneous plating of the distal tibia via a limited incision is an accepted technique of osteosynthesis for extra-articular and simple intra-articular distal tibia fractures. In this study we identify structures are risk during this approach. Thirteen unpaired adult lower limbs were used for this study. Thirteen, 16-hole synthes®LCP anterolateral distal tibial plates were percutaneously inserted according to the manufacturer instructions and confirmed by xray. Dissection was performed around the plate to examine the relation of nerves and soft tissue. The neurovascular bundle was under the plate in one case. Over the horizontal limb of the plate, typically the superficial peroneal nerve had a variable course over all four screw holes. The anterior tibial artery coursed over hole number 3 and the Extensor hallucis longistendon was positioned over hole 3 or 4. The Anterior tibialis tendon skirted hole 4 in 12 cases. Over the vertical limb of the plate, the neurovascular bundle coursed over holes, 5 to 7, the superficial peroneal nerve over holes 5 to 7.Method
Results
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. 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.Introduction
Materials and Methods
