Journal of orthopaedic trauma
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To assess the recovery of ankle function and general health status at multiple time points during the first 24 months after an isolated tibial plafond fracture treated with joint-spanning external fixation and to determine factors that affect a rapid versus a slow recovery and factors that influence patient outcome at a minimum of 2 years after injury. ⋯ In patients recovering from a tibial plafond fracture that was treated with joint-spanning external fixation, the MCS improves quickly and completely, whereas the PCS often takes 1 full year or longer to reach maximal improvement and does not completely recover, because it remains on average one standard deviation below normal at 2 years after injury. Changes in the AOS pain and disability scales between 6 and 12 months after injury were not significantly different but at all time points, the patient's ankle pain and function remains dramatically different than the normal population. These results can be used in future studies for comparison with patients treated with alternate treatment techniques and to assess the effect of important treatment variables such as stabilization techniques and quality of reduction.
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Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationale.
We describe a posterolateral transfibular neck approach to the proximal tibia. This approach was developed as an alternative to the anterolateral approach to the tibial plateau for the treatment of two fracture subtypes: depressed and split depressed fractures in which the comminution and depression are located in the posterior half of the lateral tibial condyle. These fractures have proved particularly difficult to reduce and adequately internally fix through an anterior or anterolateral approach. ⋯ Critically, the proximal tibial soft tissue envelope and its blood supply are preserved. To date, we have used this approach either alone or in combination with a posteromedial approach for the successful reduction of tibial plateau fractures in eight patients. No complications related to this approach were documented, including no symptoms related to the common peroneal nerve, and all fractures and fibular neck osteotomies healed uneventfully.
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The selection of a surgical approach for the treatment of tibia plateau fractures is an important decision. Approximately 7% of all tibia plateau fractures affect the posterolateral corner. Displaced posterolateral tibia plateau fractures require anatomic articular reduction and buttress plate fixation on the posterior aspect. ⋯ No complications and no loss of reduction were observed. Additionally, the new posterolateral approach permits direct visual exposure and facilitates the application of a buttress plate. Our approach does not require fibular osteotomy, and fragments of the posterolateral corner do not have to be detached from the soft tissue network.
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To assess the risk of injury to the superficial peroneal nerve, saphenous nerve, and saphenous vein in percutaneous fixation of the distal fibula and tibia. ⋯ The superficial peroneal nerve, saphenous nerve, and saphenous vein are at risk during percutaneous submuscular plating of the distal fibula and tibia. Careful dissection proximally for the fibula and distally for the tibia can minimize the risk of damage to these structures.