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Posteromedial Tibial Plateau Fixation in the Prone Position: Applications of the Lobenhoffer Approach

February 24, 2016

Contributors: Stephen Kottmeier, MD; Elliot Row, MD; J Tracy Watson, MD; Clifford B Jones, MD, FACS

This video demonstrates posterior ankle approach strategies for high energy fractures. The goals of treatment are to preserve motion, strength, stability, and painless function; to restore articular congruity, articular alignment, and limb axis; and to preserve regional blood supply and the soft tissue envelope. The patho-anatomy of posterior pilon versus posterior malleolus fractures is discussed, and a classification scheme is illustrated. Indications for fixation of posterior malleolar fractures are discussed. The differences between syndesmotic screw fixation alone and with posterior malleolar fixation are outlined. The protocol of staged (initial  posterior pilon fixation) strategies is described. Anterior soft tissue concerns are addressed with case discussions. The posterolateral approach to the malleolus is demonstrated. Techniques for reduction are listed. A posteromedial approach is then described, this may be appropriate with posterior malleolar fractures with medial extension. Cases where simultaneous approaches may be needed are described.

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