The anatomical relationship of the neurovascular structures in direct posterior lateral gastrocnemius split approach for posterolateral tibial plateau fractures

Abstract

Purpose To evaluate the distances between the incision and neurovascular structures in direct posterior split-gastrocnemius approach for tibial plateau fractures. Methods Thirteen fresh-frozen cadavers were used in the study. The distance between the neurovascular structures medial and lateral to the incision was measured from the tibial joint line and at a level 5 cm distal to the joint line. Results The mean distance between the incision and medial neurovascular structures was 10.09 ± 3.47 mm (range 5.63–16.51 mm) at the level of the tibial joint line and 10.39 ± 2.57 mm (range 5.79–14.09 mm) at a level 5 cm distal to the joint line. The mean distance between the incision and the common peroneal nerve was 13.44 ± 4.17 mm (range 6.28–20.72 mm) at the level of the tibial joint line and 19.56 ± 5.24 mm (range 12.58–26.74 mm) at a level 5 cm distal to the joint line. Conclusions In isolated posterolateral tibial plateau fractures, it is possible to apply anatomical reduction and buttress plating on the posterior surface with a direct posterior split-gastrocnemius approach. With a thorough understanding of the regional anatomy, this approach can be safely performed by experienced orthopaedists