Limits...
The utility and limitations of the transfibular approach in ankle trauma surgery.

Yassin M, Garti A, Khatib M, Weisbrot M, Ashkenazi U, Ram E, Robinson D - Case Rep Orthop (2014)

Bottom Line: The current report describes several cases performed using this technique establishing a rationale and safe zone for performing a transfibular approach to the distal tibia.The advantages of such approach are the excellent visualization of the lateral tibia and the articular space.The recommendation is to utilize this approach in cases of severe comminution of the lateral tibia with a relatively intact medial tibia.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Hasharon Hospital, Rabin Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, 4937211 Petah Tikva, Israel.

ABSTRACT
The commonly used extensive approaches to the distal tibia include the posteromedial and anterolateral approaches. The current report describes several cases performed using this technique establishing a rationale and safe zone for performing a transfibular approach to the distal tibia. The advantages of such approach are the excellent visualization of the lateral tibia and the articular space. The utilization of this approach involves the risk of injury to the anterior tibial vessels and to the superficial peroneal nerve as well as a requirement for syndesmosis reconstruction. The recommendation is to utilize this approach in cases of severe comminution of the lateral tibia with a relatively intact medial tibia.

No MeSH data available.


Related in: MedlinePlus

Transfibular approach to the lateral distal tibia. Note the intermediate branch of the superficial peroneal nerve as well as the anterior tibial vessels. The flipped-over lateral malleolus still retains the posterior (peroneal artery derived) blood supply.
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fig3: Transfibular approach to the lateral distal tibia. Note the intermediate branch of the superficial peroneal nerve as well as the anterior tibial vessels. The flipped-over lateral malleolus still retains the posterior (peroneal artery derived) blood supply.

Mentions: The patient was operated on in a supine position, on a tilted table. A posterolateral approach was used, as this was the only area of intact skin. An osteotomy of the fibula was performed 7 cm above the distal fracture line (Figure 3). The syndesmosis was completely torn and the distal fragment was flipped over, thus allowing extensive approach to the distal tibia. The tibia was reduced under direct vision with internal fixation done by anteriorly placed screws via a minimally invasive technique. The fibula osteotomy and the fibular fracture were reduced and fixed using a plate. Bone grafting was not necessary due to excellent bone approximation. The medial malleolus was reduced and fixed using a plate inserted via a minimally invasive technique through a 3 cm oblique incision (due to the extensive skin damage). The postoperative course was uneventful. The patient was treated with a postoperative boot for one month and began partial weight bearing after 3 weeks. Bony union was obtained after 3 months.


The utility and limitations of the transfibular approach in ankle trauma surgery.

Yassin M, Garti A, Khatib M, Weisbrot M, Ashkenazi U, Ram E, Robinson D - Case Rep Orthop (2014)

Transfibular approach to the lateral distal tibia. Note the intermediate branch of the superficial peroneal nerve as well as the anterior tibial vessels. The flipped-over lateral malleolus still retains the posterior (peroneal artery derived) blood supply.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230000&req=5

fig3: Transfibular approach to the lateral distal tibia. Note the intermediate branch of the superficial peroneal nerve as well as the anterior tibial vessels. The flipped-over lateral malleolus still retains the posterior (peroneal artery derived) blood supply.
Mentions: The patient was operated on in a supine position, on a tilted table. A posterolateral approach was used, as this was the only area of intact skin. An osteotomy of the fibula was performed 7 cm above the distal fracture line (Figure 3). The syndesmosis was completely torn and the distal fragment was flipped over, thus allowing extensive approach to the distal tibia. The tibia was reduced under direct vision with internal fixation done by anteriorly placed screws via a minimally invasive technique. The fibula osteotomy and the fibular fracture were reduced and fixed using a plate. Bone grafting was not necessary due to excellent bone approximation. The medial malleolus was reduced and fixed using a plate inserted via a minimally invasive technique through a 3 cm oblique incision (due to the extensive skin damage). The postoperative course was uneventful. The patient was treated with a postoperative boot for one month and began partial weight bearing after 3 weeks. Bony union was obtained after 3 months.

Bottom Line: The current report describes several cases performed using this technique establishing a rationale and safe zone for performing a transfibular approach to the distal tibia.The advantages of such approach are the excellent visualization of the lateral tibia and the articular space.The recommendation is to utilize this approach in cases of severe comminution of the lateral tibia with a relatively intact medial tibia.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Hasharon Hospital, Rabin Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, 4937211 Petah Tikva, Israel.

ABSTRACT
The commonly used extensive approaches to the distal tibia include the posteromedial and anterolateral approaches. The current report describes several cases performed using this technique establishing a rationale and safe zone for performing a transfibular approach to the distal tibia. The advantages of such approach are the excellent visualization of the lateral tibia and the articular space. The utilization of this approach involves the risk of injury to the anterior tibial vessels and to the superficial peroneal nerve as well as a requirement for syndesmosis reconstruction. The recommendation is to utilize this approach in cases of severe comminution of the lateral tibia with a relatively intact medial tibia.

No MeSH data available.


Related in: MedlinePlus