Orthopaedic Trauma Society - Tibial Plateau: The Posteromedial Approach

Description

The video transcript features a presentation by Dr. Sarah Gill from the Queen Elizabeth Hospital in Glasgow, focusing on proximal tibial fractures and tibial plateau fractures, particularly emphasizing posteromedial segment fractures and their management through a posteromedial approach. Dr. Gill opens by discussing the significance of understanding radiographic images, including AP and lateral views, and the use of CT scans with 3D reconstructions to enhance visualization of complex injuries.



She highlights her five key learning points: first, move beyond the traditional Schatzker classification and adopt a more nuanced understanding of fragments and instability specific to the medial side of tibial plateau fractures; second, consider using a supine positioning for surgery which can facilitate access; third, be flexible with surgical techniques such as retracting or dividing specific tendons (like pes) to improve access--stress the importance of being able to modify approaches during surgery; fourth, carefully manage the popliteus tendon to ensure access is optimized while preserving function, and fifth, diligently use retractors to maintain a clear surgical field by minimizing pressure on the neurovascular bundle.



The presentation also includes practical surgical tips, discussing patient positioning for optimal viewing of both the posteromedial and lateral aspects of the tibia, and demonstrating the approach to access and repair the fractures effectively. Dr. Gill wraps up with a discussion about the relevance of her approach in non-major trauma centers, asserting that with proper training, these operations can be successfully performed in various surgical settings. The session ends with a Q&A segment addressing concerns regarding the management of bicondylar tibial plateau fractures.

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