Erweiterter medialer und erweiterter lateraler Zugang bei Tibiakopffrakturen

Abstract

Complete visualization of the articular surface in comminuted uni- or bicondylar tibial plateau fractures as aprerequisite for anatomical reconstruction to reduce the risk of posttraumatic osteoarthritis. Unicondylar lateral or medial as well as bicondylar intra-articular tibial plateau fractures with central and/or dorsal fracture lines; comminuted destruction of the medial or lateral tibial plateau with dislocation of >2 mm. Critical soft tissue in the approach area, femoral condylar fracture, intraligamentous ruptures of the medial or lateral ligaments or the posterolateral corner. Medial: via the medial or anteromedial approach; lateral: via the antero- or posterolateral approach for open reduction and internal fixation of the tibial plateau fracture. Sharp dissection down to the medial/lateral ligamentous accompanying structures with subsequent presentation of the medial/lateral femoral epicondyle. Medial: approximately 2 × 2 cm osteotomy of the medial femoral epicondyle. Lateral: osteotomy of an approximately 1 × 1 × 0.5 cm bone block of the lateral femoral epicondyle either with protection or including the popliteus tendon running ventrally in the sulcus popliteus. In this case, aviolation of the articular condyle should be avoided. Early functional posttreatment with full mobilization and 10-20 kg partial load bearing on forearm crutches, fracture-dependent for 6-12weeks. Very good visualization of the comminuted articular surface with postoperatively anatomical reconstruction of complex fracture patterns without postoperative concomitant instabilities.