Townsend Stationery And Computers

Knee Operations

 Page 2

I guess the first question may be what is a Tibial Osteotomy (or Fulkerson Osteotomy).
Well in my layman terms it is where the doctor takes part of the Tibia and cuts part of it out to replace it in a different spot (higher). This is done to help realign the patella tracking (maltracking).

Click Thumb nails to Enlarge them.

Or for the more professionals.

- osteotomy cut:
- typically a 5-8 cm bone pedicle will be require for adequate bone healing;
- medial osteotomy cut should follow the plane of the K wires (from antero-medial to postero-lateral);
- lateral osteotomy cut is required at the most proximal part of the osteotomy and must be directed anteriorly to prevent unexpected propagation of the osteotomy;
- typically this is carried out w/ an osteotome;
- care is taken to leave an intact distal taper of bone, which serves as a hinge;
- note that the deep peroneal nerve and the anterior tibial artery lie on the interosseous membrane, near the posterior cortical surface;

< the position>
- determine the position of the tuberosity which allows the best excursion of the patella in the intercondylar groove;
- usually no more than 1 cm of medialisation is needed;
- if necessary, the distal aspect of the tuberosity fragment can be removed, so as to allow distal advancement of the fragment (which might be useful w/ patella alta);

- fixation:
- fixation is carried out w/ 4.5 cortical screw (as a lage screw);
- the bone tap should be carefully applied to avoid neurovascular injury;
- note that there has be anecdotal reports of vascular injuries from insertion of self tapping screws which protrude beyond the cortex;
- after insertion of the first screw, take the knee through a range of motion to confirm optimal tracking;
- often two bone screws are needed;
- as noted by Morshuis et al, 24 out of 25 patients had pain over the screw site, which required subsequent screw removal;
- consider counter-sinking of the screw holes to reduce prominence;

- complications:
- pain over the screw site in most patients;
- loss of ability to kneel down;

- ref:
Anteromedial tibial tubercle transfer without bone graft.
JP Fulkerson MD, GJ Becker MD, JA Meaney MD, M Miranda, and MA Folcik
The American Journal of Sports Medicine. Vol 18, No 5. 1990. pp 490.
Anteromedialization of the tibial tuberosity for patellofemoral malalignment.
Fulkerson JP.
CORR 177: 176-181, 1983.

This extract is taken from MedMedia

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