Treatment of Posterior Fractures of the Tibial Plateau Via the Improved Posteromedial Approach

Abstract：Objective To explore anatomic basis of posteromedial approach and treatment of posterior fractures of the tibi-al plateau via the improved posteromedial approach. Methods a)The main vessels,nerves,muscles and ligaments related to the posteromedial approach were observed and measured on 25 lower limbs of adult cadavers,including 20 formalin fixed speci-mens and 5 fresh frozen specimens. b)To make sure the practicality of the posteromedial approach,surgical simulations were performed on another 5 lower limbs of fresh adult cadavers. c)The approach was clinically applied on 13 cases. According to AO classification,there were 2 cases of type 41-B-1. 3. 2 and 2 cases of 41-B-3. 2. 2 and 4 cases of 41-C-1. 3 and 5 cases of 41-C-3. 3. By the way a prone in treatment of tibial plateau fracture type B,supine position with the way the combined antero-lateral tibial plateau fracture type C treatment,the clinical characteristics and the treatment outcome were also analyzed. Re-sults The operative incision of this approach can avoid to reach the common nerve and vessel trunk. The vascular nerve bun-dles were protected when the deep dissections were carried on in the intermuscular septum between the medial side of gastroc-nemius and semimembranosus. The vessels and nerves were protected by the stripped popliteus. Medial inferior genicular artery can be ligated when necessary. Satisfactory results were obtained in all 13 cases adopting this approach. Conclusion The im-proved posteromedial approach is an effective approach for the treatment of posterior fractures of the tibial plateau,because it is less invasive,safe,simple in anatomy,direct and sufficient in exposure.