The medial head of the gastrocnemius detaching approach for the treatment of complicated tibial plateau fracture with posterolateral fragments: A case report

Abstract text (incl. references and figure legends)

Case history: 45 years old, male

He twisted his knee while skiing and became unable to walk.

Clinical findings:

Significant swelling and pain were observed around the knee joint. He had no peripheral perfusion abnormalities and neurologic deficits.

Investigation/Results:

X-rays and computed tomography revealed tibial plateau fracture with posteromedial and posterolateral disruption.

Diagnosis:

It was diagnosed as a tibial plateau fracture (Schatzker type V PL+PM).

Therapy and Progressions:

On the day of injury, temporary external fixation was performed, and the location of the displaced posterolateral fragment within the joint was confirmed arthroscopically. On the day 14, the intra-articular fragment was extracted by small incision in the supine position. Then, screw fixation to the precisely reduced posterolateral fragment and plate fixation to the posteromedial fragment were performed by the posterior approach in the prone position. The medial head of the gastrocnemius was detached at the origin of the femur to obtain a good visual field of the posterior aspect of the proximal tibia（Fig.1） and achieved anatomical reduction and fixation to the posterolateral fragment. Bone union was observed 3 months after the operation.

Comments:

This approach allows for a better field of view to the fracture site in the posterolateral proximal tibia than Burks or Frosch approach, and is considered to be very useful for accurate reduction and fixation of posterolateral fragments. There was concern that removing the medial head would reduce the ankle plantar flexor strength, but by the tendinous repair using suture anchors, the strength has recovered to almost the same level as that of the unaffected side.

References:

1, Kramers-de Quervain. J Bone Joint Surg Am. 2001;83:239-246.

2, Mauricio Kfuri. Injury. 2018;49:2252–2263.

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