Gastrocnemius raphe split approach for complex proximal tibia fractures-Applicability and advantages

Area of Science:

• Orthopedic Surgery
• Traumatology
• Lower Extremity Fractures

Background:

• Posterior column tibial plateau fractures present significant challenges in surgical management.
• Existing surgical approaches often provide inadequate exposure to the posterior column, leading to poor outcomes such as malreduction, subluxation, arthritis, and chronic pain.

Purpose of the Study:

• To evaluate the efficacy and applicability of the posterior midline gastrocnemius raphe split approach for complex tibial plateau fractures involving the posterior column.
• To determine if this approach provides adequate exposure for fracture manipulation and implant placement in the posterior tibial plateau.

Main Methods:

• A retrospective study involving 22 patients with tibial plateau fractures affecting the posterior column.
• The posterior midline gastrocnemius splitting approach was utilized, either as a standalone procedure or in combination with other surgical techniques.
• Patient demographics, surgical approach, fracture union, loss of reduction, and knee range of motion were assessed.

Main Results:

• Radiological union was achieved in an average of 13 weeks (range 10-15 weeks) with no observed loss of reduction during the 12-month average follow-up (range 6-14 months).
• Patients regained painless knee flexion, averaging 120°.
• The approach demonstrated versatility, allowing adequate exposure to both quadrants of the posterior tibial plateau and compatibility with other surgical techniques.

Conclusions:

• The posterior midline gastrocnemius splitting approach is a valuable and versatile surgical option for managing complex tibial plateau fractures involving the posterior column.
• This technique facilitates adequate visualization and manipulation, leading to successful fracture healing and good functional recovery.
• Its ability to be combined with other approaches enhances its utility for addressing multi-fragmentary injuries and associated ligamentous damage.