Detaillierte Beitrags-Information
| Beitragstitel | Surgical access to proximal tibio-fibular joint problems |
|---|---|
| Beitragscode | P053 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
Introduction Access to the tibio-fibular joint is limited due to the surrounding soft tissue coverage and vicinity of the peroneal nerve. In lateral tibia plateau fractures, trans-fibular approaches to address the comminuted poster-lateral joint surface have been described 1) 2) – however there is no description of approaches to treat pathologies of the proximal tibio-fibular joint. Objectives We present the approach used in 2 cases to treat articular neoplasms of the proximal tibio-fibular joint. Patients Case 1: Female patient (50y), with chondromatosis of the proximal tibio-fibular joint. A first attempt elsewhere by partial resection from posterior failed and the patient suffered from persistent pain. Full exposure of the joint by a subcapital osteotomy with proximal reflexion of the fibular head and the lateral collateral ligament after release of the common fibular nerve (CFN) allowed complete resection of the chondromatosis. The fibular head was then arthrodesed to the tibia with 2 screws, while the subcapital osteotomy was left without osteosynthesis. The arthrodesis healed uneventfully as well as the subcapital osteotomy within 10 weeks, painfree jogging was possible 12 weeks after the procedure. Case 2: Male patient (50y), with osteo-chondroma of the proximal fibula at the level of the tibio-fibular joint. A similar approach after exposure of the CFN was performed, with full resection of the osteo-chondroma and arthrodesis of the joint. The arthrodesis with 2 screws as well as the osteotomy united within 8 weeks, providing painfree unlimited function of the knee joint. Results There were no complications during the procedure or in the postoperative follow-up period. The tibio-fibular arthrodesis healed uneventfully, the patients were painfree with unrestricted function after 8 and 10 weeks, respectively. There were no problems encountered from the common fibular nerve (CFN) after full exposure of the nerve during surgical exposure. Conclusion This appearingly rather detouring approach allowed full visualization of the proximal tibio-fibular joint to treat the underlying pathology. Healing of the subcapital fibula osteotomy in our cases did not need special attention and the approach led to high patient satisfaction after short rehabilitation. Reference 1) P. Lobenhoffer et al.; Unfallchirurg 12-97 (1997): 957-967 2) B. Yu et al.; The Knee 17 (2010): 313-318 |