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

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.