Date post: | 12-Apr-2017 |
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TIBIAL PLATEAU TIBIAL PLATEAU FRACTURESFRACTURES
Angga Fiandana
Surgical Anatomy
Surgical Anatomy
Mode of injury
Varus or valgus force combined with axial loading
ClassificationSCHATZKERHOHL AND MOORE
Classification : SCHATZKER
Classification : HOHL AND MOORE
TreatmentNon OperativeOperative
Treatment : Goals
1. restoration of articular congruity, 2. axial alignment, 3. joint stability, 4. functional motion.
Treatment : OperativeThe absolute indications : 1. open tibial plateau fracture 2. a tibial plateau fracture combined with
vascular lesion.
The relative indications :1. most displaced bicondylar fractures2. displaced medial condylar fractures 3. lateral plateau fractures that result in joint
instability.
PrognosisFour primary factors determine the
prognosis 1. the degree of articular depression; 2. the extent and separation of the
condylar fracture lines; 3. the degree of diaphyseal-metaphyseal
comminution and dissociation 4. the integrity of the soft tissue envelope
Treatment : Operative
Treatment : Operative
Fixation :1. External Fixator2. Screw3. Plate : L plate or T plate4. K wire
SURGICAL TECHNIQUE
Positioning
Surgical Approach
Surgical Approach
Anterolateral approach Anteromedial approach Universal Approach Posterior Approach
Anterolateral Approach
Surgical Approacho The flaps that are raised must be full
thickness, consisting of the subcutaneous fat down to the fascia.
o The meniscus must be preserved and should never be excised to facilitate exposure. Submeniscal arthrotomy should be performed to gain visualization of the articular component
o Bone graft should be considered for depressed fracture
Postoperative Care Position : elevated limb Movement : as soon as possible Non weight bearing for 10 – 12
weeks X ray monitoring : after 6, 10, 16
weeks, and prior to implant removal Plate removal 12 – 18 months
Complication Early : compartment syndrome Late :
1. Joint stiffness2. Deformity3. Osteoarthritis
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