Tibial Plateau Fractures

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Tibial Plateau Fractures

• Presented by
• Spencer F. Schuenman, D.O.

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Classification - AO
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Classification - Schatzker
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Why Ilizarov?
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Biomechanical advantage4 wires a screw are as
strong as two plates(T. Watson)Fibular head
wire will increase stability up to 30
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Indications

• Open Fx
• Degloving injury
• Compromised skin
• Severe comminution
• Shaft extension

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Objectives

• Joint congruity
• Axial alignment
• Stable fixation
• Functional ROM WB
• Soft tissue healing

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Pre-op evaluation

• Skin soft tissues
• Radiographs
• CT scan

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Fracture topography

• Condylar comminution
• Tibial tubercle Fx.
• Posterior cortex
• Metaphysis, shaft

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Fracture reduction

• Skeletal traction
• Closed reduction
• Percutaneous reduction
• Open reduction

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Reduction first(or possibility of reduction)-
Articular surface - Metaphysis, ShaftFrame
applicationafter
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Tibial plateauMedial Lateral

• Larger Smaller
• Stronger Weaker
• Higher Lower
• Concave Convex
• Meniscus small Meniscus large

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Wire placement

• 3-point fixation (in 3 planes coronal, axial,
  saggittal)
• Olive wires only
• Push olive wires
• Pull olive wires

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3
1
4
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Drop wire
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Medial Fx.
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1
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Drop wire
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Anterolateral Fx.
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Push wire
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3
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Coronal split - reduce the split first
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Pull wire
Drop wire
Bicondylar comminution with pull wire to avoid
clustering on the ring
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Safe wire placement (JOT May 1999 Thomas
A.DeCoster et al )-safe corridors for wire
placement-extent of capsular attachment
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Capsular attachment
Zone I - less than 6 mmZone II - up to 12
mmZone III - up to 30 mmZone IV-12 mm (8-14 mm)
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-Other points -10 of cases, the knee joint
communicates with the proximal tibiofibular
joint -pes anserinus bursa a symptomatic
wire
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Femoral ring

• Severe comminution
• (AO - B3,C3)
• Articular surface inst.
• Metaphyseal diaphyseal separation
  (Schatzker VI)
• Ligamentous instability

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Complications

• Fx. related
• Surgeon related
• Patient related

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Complications

• Subchondral collapse
• Technical errors
• Poor Fx reduction
• Wrong wires
• Wrong frame
• Instability
• Patient compliance

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Conclusions

• It is up to you
• In our hands the best results are with closed
  reduction and Ilizarov frame application