Lateral/medial parapatellar arthrotomy of the pediatric proximal tibia
1. Indications
This approach is used for treatment of intraarticular fractures, avulsions, and flake (osteochondral) fractures.
Periosteal stripping or physeal compression should be avoided.
2. Skin incision
Start the skin incision proximally at the level of the lower pole of the patella and extend it to the tibial physis on either side of the patellar tendon.
The incision may be extended (dotted line) if exposure of the articular surface is necessary for reduction and fixation.
Incise the capsule in the line of the skin incision.
Once the knee capsule is incised, retractors can be used to improve visualization of the fracture site.
Pitfall: Be careful to avoid sharp dissection around the meniscus.
3. Wound closure
Repair the joint capsule with absorbable sutures.
Close the skin and subcutaneous tissues according to surgeon preference.
