Dual-incision minimally invasive fasciotomy of the anterior and peroneal compartments for chronic exertional compartment syndrome of the lower leg

To evaluate the risk of iatrogenic injury when using a dual-incision minimally invasive technique to decompress the anterior and peroneal compartments of the lower leg. Forty lower extremities from 20 adult cadavers, embalmed with Thiel’s method, were subject to fasciotomy of the anterior and peroneal compartment using a dual-incision minimally invasive fasciotomy. The first incision was made 12 cm proximal to the lateral malleolus to identify and protect the superficial peroneal nerve (SPN). The second incision was made at the mid-point of the Fibula (half-way between the fibular head and the lateral malleolus). Release of the anterior and peroneal compartments was successful in all specimens. Two nerve injuries of the superficial peroneal nerve were reported. More precisely, in these cases the medial dorsal cutaneous nerve got injured during the fascial opening of the extensor compartment. Two incision minimally invasive fasciotomy to decompress the anterior and peroneal compartments of the lower leg appears to be safe with regard to the results of this study.

Clinical comparison of single-incision and dual-incision approaches for the treatment of distal tibial and fibular fractures: A randomized controlled trial

Purpose: The purpose of this study was to clinically compare the single-incision and dual-incision approaches for the treatment of distal tibial and fibular fractures. Methods: In total, 93 patients were enrolled, and the mean follow-up was 15 months (range 12–19 months). The patients treated for open reduction and internal fixation were randomly classified into two groups based on the approach used: 45 patients were treated using the single-incision approach (group 1) and 48 patients were treated using the dual-incision approach (group 2). In these two groups, operation time, discharge time, postoperative complications, and ankle function evaluations (Olerud–Molander Ankle Score) were compared between the two groups. Results: There were no significant differences in the mean operation time (98.2 ± 18.5 vs. 103.6 ± 19.3), discharge time (11.1 ± 3.9 vs. 12.5 ± 5.7), overall surgical complication rates (9/45 vs. 15/48), or ankle function between the two groups ( p > 0.05). However, the rate of soft tissue-related complications, such as skin slough, infection, nonunion, and delayed union, was significantly lower in group 1 (5/45) than in group 2 (14/48) ( p < 0.05). Conclusion: The two incision approaches were found to have similar clinical outcomes. However, with regard to soft tissue conservation, the single-incision approach was superior to the dual-incision and maybe a reliable alternative.

Prospective study of management of Schatzker’s type V & VI tibial plateau fractures by different types of plate osteosynthesis

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Schatzker‘s type V and type VI fractures are bicondylar tibial plateau fractures which pose a challenge to the treating orthopaedician. Several studies have compared unilateral locked plate and double plating for their treatment and showed no statistically significant difference between these two fixation methods. So the quest for ideal implant for internal fixation (unilateral plating and dual plating) of these fractures continues. Hence we decided to do this study.</span></p><p class="abstract"><strong>Methods:</strong> A prospective study of Surgical Management of thirty seven cases of Schatzker’s type V and VI tibial plateau fractures by different types of plate osteosynthesis (single unilateral locking plate and dual incision locking buttress plate) was carried out. The functional outcomes were assessed by the hospital for special surgery knee score system.<strong></strong></p><p class="abstract"><strong>Results:</strong> 18 patients were fixed with a unilateral locking plate, 19 patients were fixed with a dual incision bilateral locking plates. All patients had satisfactory articular surface reduction and axis of alignment on immediate postoperative radiographs. All cases achieved union by 4.8 months approximately. All patients had either excellent or good HSS score. Mean HSS score at recent follow-up was 86.10 in DP group and 83 in SP groups (t value 2.81, p values 0.008)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> We conclude that single plating and dual plating fixation of complex proximal tibial plateau fracture Schatzker‘s type 5 and type 6 ensures stable fixation, immediate mobilization, satisfactory radiological outcome, very high union rates and excellent functional assessment outcome with a very low rate of complications<span lang="EN-IN">.</span></p>