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Boluda-Mengod J, Olías-López B, Forcada-Calvet P, Martín-Herrero A, Herrera-Pérez M, Álvarez-De-La-Cruz J, Herrera-Rodríguez A, Pais-Brito JL. Modified Oblique Lobenhoffer (MOL) approach for posterolateral and posteromedial column access in tibial plateau fractures: a detailed cadaveric anatomical study. J Orthop Traumatol 2024; 25:27. [PMID: 38769283 PMCID: PMC11106229 DOI: 10.1186/s10195-024-00769-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/08/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Tibial plateau fractures involving posteromedial (PM) and posterolateral (PL) columns are complex injuries that require an appropriate approach. The management of the PL column in these cases can be controversial, and limitations using deep posteromedial interval approaches have been referenced. In this paper, a modification of the Lobenhoffer approach, designed to optimize the access to the PL column, is described in detail. The aim of this study was to assess the feasibility of this approach in a cadaveric anatomical study. MATERIALS AND METHODS In total, five fresh-frozen cadaveric specimens were used for detailed anatomical study surrounding the approach. Relationships with cutaneous and deep neurovascular structures were evaluated. The exposure area of the PL and PM columns using this approach was assessed. RESULTS The cadaveric study showed safe and adequate exposure. Oblique skin and fascia incision just medial to the posterior midline was safe to protect the medial sural cutaneous nerve and the small saphenous vein. Elevation of the popliteus and tibialis posterior muscles offered safe protection of the anterior tibial artery and popliteal neurovascular bundle during retractor placement. Adequate full proximal exposure of the PM and PL columns, including the posterolateral lateral (PLL) and posterolateral central (PLC) segments, was obtained in all specimens. CONCLUSIONS The Modified Oblique Lobenhoffer (MOL) approach can be a feasible option to access PL and PM columns in tibial plateau fractures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Juan Boluda-Mengod
- Orthopaedic Trauma Unit, Department of Orthopaedics, Hospital Universitario Canarias (HUC), Carretera Ofra S/N, 38320, La Laguna, Tenerife, Spain.
- Department of Orthopaedics, Hospital Universitario Canarias (HUC), Carretera Ofra S/N, 38320, La Laguna, Tenerife, Spain.
- Faculty of Medicine, Universidad de La Laguna (ULL), Campus de Ofra, S/N, 38071, La Laguna, Tenerife, Spain.
| | - Beatriz Olías-López
- Orthopaedic Trauma Unit, Department of Orthopaedics, Hospital Universitario Canarias (HUC), Carretera Ofra S/N, 38320, La Laguna, Tenerife, Spain
- Department of Orthopaedics, Hospital Universitario Canarias (HUC), Carretera Ofra S/N, 38320, La Laguna, Tenerife, Spain
| | - Pau Forcada-Calvet
- Department of Anatomy, Faculty of Medicine, Universitat de Lleida (UdL), Avinguda de L'Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - Azucena Martín-Herrero
- Orthopaedic Trauma Unit, Department of Orthopaedics, Hospital Universitario Canarias (HUC), Carretera Ofra S/N, 38320, La Laguna, Tenerife, Spain
- Department of Orthopaedics, Hospital Universitario Canarias (HUC), Carretera Ofra S/N, 38320, La Laguna, Tenerife, Spain
| | - Mario Herrera-Pérez
- Department of Orthopaedics, Hospital Universitario Canarias (HUC), Carretera Ofra S/N, 38320, La Laguna, Tenerife, Spain
- Faculty of Medicine, Universidad de La Laguna (ULL), Campus de Ofra, S/N, 38071, La Laguna, Tenerife, Spain
| | - Javier Álvarez-De-La-Cruz
- Department of Orthopaedics, Hospital Universitario Canarias (HUC), Carretera Ofra S/N, 38320, La Laguna, Tenerife, Spain
| | - Alejandro Herrera-Rodríguez
- Department of Orthopaedics, Hospital Universitario Canarias (HUC), Carretera Ofra S/N, 38320, La Laguna, Tenerife, Spain
| | - José Luis Pais-Brito
- Department of Orthopaedics, Hospital Universitario Canarias (HUC), Carretera Ofra S/N, 38320, La Laguna, Tenerife, Spain
- Faculty of Medicine, Universidad de La Laguna (ULL), Campus de Ofra, S/N, 38071, La Laguna, Tenerife, Spain
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Tarasiuk A, Tubbs RS, Zielinska N, Karauda P, Gonera B, Olewnik Ł. Variations of the popliteal artery: a review. Ann Anat 2023; 249:152100. [PMID: 37105405 DOI: 10.1016/j.aanat.2023.152100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Abstract
The popliteal artery is located in the popliteal fossa. In addition to its other branches, it divides into two terminal branches, the anterior and posterior tibial arteries, which are subject to numerous morphological variations. The purpose of this review is to compile several authors' classifications of the patterns of terminal branching of the popliteal artery among adults and to describe the division among foetuses, as described in the current literature. Pathologies of the popliteal artery such as popliteal artery aneurysm and popliteal artery entrapment syndrome and methods for treating them, like open surgery and endovascular interventions are also discussed. Awareness of the morphological variations of the popliteal artery is important for radiologists and surgeons as it allows the risk of complications during surgery to be reduced.
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Affiliation(s)
- Aleksandra Tarasiuk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, Grenada; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA; University of Queensland, Brisbane, Australia
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
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