Posterior approach to the proximal tibia
1. Principles
The posteromedial side can be approached without exposing and dissecting the neurovascular structures. This approach allows repair of avulsion fractures of the posterior cruciate and tangential fractures of the proximal tibial head.
2. Skin incision
With the patient in a prone position make a lazy S-shaped skin incision in the popliteal fossa.
The incision should extend about 8 cm proximally and distally from the joint line.
3. Open crural fascia
Open the crural fascia. Identify and save the short saphenous vein and the medial sural cutaneous nerve.
4. Deep dissection
Identify the semimembranosus muscle and retract it medially. The insertion of the medial head of gastrocnemius becomes visible.
5. Exposure of postero-medial knee capsule
Identify the anterior edge of the gastrocnemius and transect it close to its insertion and retract the freed muscle laterally. The muscle will protect the important neurovascular bundle.
The postero-medial capsule comes into view. It can be incised where necessary to expose the fracture lines.
6. Wound closure
Reattach the medial head of the gastrocnemius. Place a deep suction drain. Carry out a routine closure of the soft tissues.
