Gastrocnemius raphe split approach for complex proximal tibia fractures—Applicability and advantages. Issue 12 (December 2018)

• Record Type: Journal Article
• Authors: Chouhan, Devendra K.; Dhillon, Mandeep Singh; Puneeth, K.; Ponnusamy, Vivek; Kanaujia, Rajendra; Prakash, Mahesh
• Is Part Of: Injury. Volume 49:Issue 12(2018)
• Page Start: 2269
• Page End: 2274
• Publication Date: 2018-12
• Subjects: Posterior column fracture -- Posterior midline -- Gastrocnemius split -- Tibial plateau -- Buttress plate -- Shear fracture; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2018.09.011
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Typographical and grammatical errors corrected. Alternation in the figure numbers. Figure legends are more detailed. Changed the Conclusion as suggested by the reviewer. Abstract: Posterior column fractures of the tibial plateau have been considered problem injury as many authors reported poor outcome. Commonly used surgical approaches have limitations in addressing complex fractures involving the posterior column, leading to malreduction and subsequent leading to chronic posteroinferior subluxation, arthritis and chronic pain. There is thus a need for a surgical approach, which can provide adequate exposure to both quadrant of posterior column, in addition to allowing sufficient space for fracture manipulation and implant placement. The authors have evaluated the applicability of the posterior midline gastrocnemius raphe split approach to deal with coomplex posterior column fragment in tibial plateau fractures. A midline gastrocnemius splitting approach was used alone or along with other approaches in 22 patients with tibial plateau fractures involving the posterior column. The mean age of the patients was 36 years and the female to male ratio was 1:6 (3 and 18). At an average follow up of 12 months (Range 6–14 months), Radiological evidence of union was noted at an average 13 weeks (Range, 10-15weeks) and no loss of reduction was seen at follow-up. All cases had regained painless knee flexion that averaged 120°. The midline gastrocnemius splitting approach is a versatile approach, which allows adequate exposure on either side of the posterior tibial plateau. This can easily combined with other approaches, where the anteromedial and anterolateral coloumn or associated ligament injury demand attention.