Topographic and anatomical substantiation of a novel surgical technique for treating impression fractures and deformities of the proximal tibial epiphysis

Objective: to substantiate the feasibility and safety of a new surgical treatment method for patients with impression fractures and deformities of the posterolateral proximal tibial epiphysis from a topographic and anatomical standpoint. Materials and Methods. The study was conducted on 11 unfixed lower limb specimens obtained from six deceased individuals aged 52 to 64 years. The experiment was performed in two series. In the first series, the proposed surgery was simulated on three specimens, followed by dissection to assess the risk of damage to anatomical structures. In the second series, horizontal cuts with epoxy plastination (according to the method by D.A. Starchik) were made on eight specimens after the operation, and morphometry was performed. Results. In the first series of experiments, the technique of the proposed treatment method was tested, and nonexistent risk of damage to important neurovascular structures was confirmed. In the second series, the shortest distances from the fixation screw to the neurovascular structures were determined. The popliteal vein, popliteal artery, tibial nerve, and common peroneal nerve were located at a distance of 20.1–24.8 mm, 16.2–23.2 mm, 17.8–24.5 mm, and 13.2–24.1 mm, correspondingly. Conclusion. The effective technique of the proposed method was experimentally developed. The anatomical safety of the intervention was confirmed: the tibial nerve and popliteal vessels were located outside the risk area. The identified risk of injury to the common peroneal nerve during fibular head mobilization is minimized by correct execution of the technique.