The “FCR” Approach to the Knee for the Management of Posterior Tibial Plateau Fractures

Berwin, James T; Donovan, Richard L; Riddick, Andrew; Kelly, Michael

doi:10.1097/bot.0000000000001716

Cited by 10 publications

(7 citation statements)

References 13 publications

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“…Berwin et al described a safe posterior approach via a single longitudinal incision similar to that employed in the flexor carpi radialis approach for the wrist [ 29 ]. This incision is similar to our PM incision, and less dissection on neurovascular bundle was needed in this modified approach than in traditional DP approach [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The PM and PL approaches can be used in combination or alone, depending on the location of the tumor. The SP approach on both sides of the knee allows for individual focused medial or lateral posterior exposure and avoids unnecessary wound extension and soft-tissue dissection [ 29 , 32 ]. However, it is difficult to eradicate all DPVNS tissue, even using open synovectomy.…”

Section: Discussionmentioning

confidence: 99%

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Modified posterior approach of the knee in patients with diffuse pigmented Villonodular synovitis: case series of a single Institution’s experience

Wei

Yang

2022

BMC Musculoskelet Disord

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Background Diffuse pigmented villonodular synovitis (DPVNS) is a challenging tumor-like disorder that mainly occurs in the anterior aspect of the knee joint. The growth may sometimes extend to the posterior knee joint. Surgical excision is the mainstream treatment for DPVNS, and the posterior approach of tumor excision is adopted when the dominant tumor shows posterior extension. However, the optimal surgical approach over the posterior knee remains unknown. Methods Patients with DPVNS of the knee joint who received the posterior approach of synovectomy from 1995 to 2019 were retrospectively reviewed to describe the modified separate posterior (SP) approaches, and evaluate the treatment outcomes in a case series of DPVNS knees. The results of the SP approach was also compared with those of traditional direct posterior (DP) approach. Postoperative functional outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) standardized questionnaire and clinician-completed Musculoskeletal Tumor Society (MSTS) functional rating system at outpatient department. Results A total of 20 DPVNS knees were included. Thirteen patients who received SP approaches were included in the SP group, while seven patients who received the DP approach were included in the DP group. The median follow-up times were 5.7 years (IQR, 2-8.8) in the SP group and 3 years (IQR, 2-5.3) in the DP group. Both groups showed satisfactory safety. The SP group presented higher postoperative mean WOMAC (91.23 ± 7.20) and mean MSTS (24.23 ± 2.68) than the DP group (mean WOMAC: 76.00 ± 16.57; mean MSTS: 22.43 ± 4.69). The Wilcoxon signed-rank test was use to compare preoperative and postoperative range of motion (ROM) for each group. The significant difference in SP group (p = 0.004) was found while p = 0.131 in DP group. Conclusions The SP approach provides an effective approach with satisfactory outcomes for the surgical treatment of DPVNS knees.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Modified posterior approach of the knee in patients with diffuse pigmented Villonodular synovitis: case series of a single Institution’s experience

Wei

Yang

2022

BMC Musculoskelet Disord

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“…A 72 year old female sustaining a left-sided tibial plateau fracture due to a fall with a motor scooter. The posteromedial approach has been described by several authors under several names and in different configurations [56][57][58][59]. The inverse L-configuration allows for more visualization towards the lateral aspect of the posterior articular surface [47].…”

Section: Evolving Perspectivesmentioning

confidence: 99%

“…Careful creation of a fasciocutaneous flap will function as protection for sural structures. Berwin et al proposed a more lateral incision to increase visualization towards the lateral tibial aspect, however with increasing risk of damage to the sural structures [57]. All described approaches dissect along the medial border of the gastrocnemius muscle, in order to retract it laterally.…”

Section: Evolving Perspectivesmentioning

confidence: 99%

Why address posterior tibial plateau fractures?

Berg

Quintens

Zhan

et al. 2020

Injury

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Management of posterior tibial plateau fractures has gained much interest over the past few years. Fracture morphology, trauma mechanism, and soft-tissue injury have been identified as the key factors determining the treatment strategy and outcome. We provide a rationale for the operative management of posterior tibial plateau fractures by discussing the interplay between fracture morphology, trauma mechanism, and softtissue injury. The trauma mechanism has proven to be an important tool, not only to understand fracture morphology, but also to assess concomitant soft-tissue (i.e. ligamentous) injury. Subsequently, soft-tissue injury might play a role in future classification and diagnostic work-up of tibial plateau fractures, particularly in fractures with posterior involvement. Plate osteosynthesis using a posterior approach is safe and should be considered routinely in coronal fractures of the posterior tibial plateau, as illustrated

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“…the years of the classic technique as "S -shape" [5], "L -type" incision [16], and lastly the "FCR"' approach to the knee [17].…”

Section: Structures In Dangermentioning

confidence: 99%

Surgical Approaches and Leg Positions for Tibial Plateau Fractures

Triantafyllos¹,

Ditsios²,

Δίτσιος³

2020

Tibia Pathology and Fractures

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Tibial plateau fractures are a common orthopedic injury. Epidemiological studies have shown that these injuries appear in younger or older patients with different mechanisms of injury. For better long-term results, it is crucial to achieve successful fracture reduction, thus avoiding the main complication, which is post-traumatic arthritis. Reduction can be achieved by choosing the proper surgical approach. Many approaches that address the fractures of the tibial plateau have been described in international literature. In the past, the direct anterior midline approach was used, which required a large detachment of the soft tissues. Nowadays, the percutaneous approach, the anterolateral approach, the medial approach, the posteromedial approach, the posterolateral approach, and the direct posterior approach are used by orthopedic surgeons to treat these kinds of fractures. In this chapter, we will describe the surgical approaches available for tibial plateau fractures and the possible positions of the affected leg.

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The “FCR” Approach to the Knee for the Management of Posterior Tibial Plateau Fractures

Cited by 10 publications

References 13 publications

Modified posterior approach of the knee in patients with diffuse pigmented Villonodular synovitis: case series of a single Institution’s experience

Modified posterior approach of the knee in patients with diffuse pigmented Villonodular synovitis: case series of a single Institution’s experience

Why address posterior tibial plateau fractures?

Surgical Approaches and Leg Positions for Tibial Plateau Fractures

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