approaches

Distal Tibial Fractures

Definition

Metaphyseal

Extra-articular

Intra-articular Extension

Approaches

Medial Parapatellar

Medial

Lateral

Posterior

Modified Posterior

Medial Parapatellar Approach

Indications

Synovectomy 

Patellectomy 

TKR

Technique

Region specific approaches

Theory

- want to traverse one muscle / one compartment

- keep away from NV bundle

- as a rule perform open biopsy through compartment the tumour is in

- this is the compartment that will require surgical removal in wide excision

- direct approach without going through muscle if possible i.e. tibia, distal ulna

Lower Limb

Thigh

General Principles

All possible length should be preserved consistent with clinical judgement

- function of amputated stumps decrease progressively with each higher level of amputation 

- prosthetic rejection by patient increases with the more proximal amputations

- most ADL'S can be performed adequately with one limb, so don't use prosthesis

- all nerves are drawn distally into wound & sectioned so they retract well proximally to bone level of amputation