Table 1 Surgical exposure to posterolateral quadrant tibial plateau fractures: an anatomic comparison of posterolateral vs posteromedial approaches
Posterolateral approach | Posteromedial approach | |
|---|---|---|
Skin incision | Direct straight incision | Indirect inverted L-shaped incision |
Superficial structure | Lateral sural cutaneous nerve | Medial sural cutaneous nerve |
Greater saphenous vein and saphenous nerve | ||
Deep exposure | Via the lateral board of lateral gastrocnemius head and soleus | Via the medial board of medial gastrocnemius head and soleus |
Expose of posterolateral tibial plateau | 1. Directly, part of the articular surface can be seen | 1. Indirect, direct vision of the articular surface is impossible |
2. Superiorly traction of the popliteal muscle or partial dissection | 2. Lateral and inferiorly traction of the popliteal muscle | |
3. Dissection of the posterolateral corner structure | 3. No dissection of the AVN or PLC | |
4. Partially shielded by fibular head | ||
Plate placement | Straightly | Obliquely |
Direction of screws | Direct to the middle or medial side | Direct to the lateral side |
Dangerous structure | CPN, ATA | Popliteal vessels |
Remove the plate | Very hard, may injury the ATA or ATV | Hard for strong persons |
Clinical usage | Isolated PL fractures | Bicondylar posterior fractures |
Complex fractures | Complex fractures |