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Tibial Plateau Fractures

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Tibial Plateau Fractures Presented by Spencer F. Schuenman, D.O. Classification - AO Classification - Schatzker Why Ilizarov? Biomechanical advantage 4 wires & a ... – PowerPoint PPT presentation

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Title: Tibial Plateau Fractures


1
Tibial Plateau Fractures
  • Presented by
  • Spencer F. Schuenman, D.O.

2
Classification - AO
3
Classification - Schatzker
4
Why Ilizarov?
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10
Biomechanical advantage4 wires a screw are as
strong as two plates(T. Watson)Fibular head
wire will increase stability up to 30
11
Indications
  • Open Fx
  • Degloving injury
  • Compromised skin
  • Severe comminution
  • Shaft extension

12
Objectives
  • Joint congruity
  • Axial alignment
  • Stable fixation
  • Functional ROM WB
  • Soft tissue healing

13
Pre-op evaluation
  • Skin soft tissues
  • Radiographs
  • CT scan

14
Fracture topography
  • Condylar comminution
  • Tibial tubercle Fx.
  • Posterior cortex
  • Metaphysis, shaft

15
Fracture reduction
  • Skeletal traction
  • Closed reduction
  • Percutaneous reduction
  • Open reduction

16
Reduction first(or possibility of reduction)-
Articular surface - Metaphysis, ShaftFrame
applicationafter
17
Tibial plateauMedial Lateral
  • Larger Smaller
  • Stronger Weaker
  • Higher Lower
  • Concave Convex
  • Meniscus small Meniscus large

18
Wire placement
  • 3-point fixation (in 3 planes coronal, axial,
    saggittal)
  • Olive wires only
  • Push olive wires
  • Pull olive wires

19
3
1
4
2
Drop wire
2
Medial Fx.
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1
4
Drop wire
2
3
Anterolateral Fx.
21
Push wire
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3
4
1
2
Coronal split - reduce the split first
24
Pull wire
Drop wire
Bicondylar comminution with pull wire to avoid
clustering on the ring
25
Safe wire placement (JOT May 1999 Thomas
A.DeCoster et al )-safe corridors for wire
placement-extent of capsular attachment
26
Capsular attachment
Zone I - less than 6 mmZone II - up to 12
mmZone III - up to 30 mmZone IV-12 mm (8-14 mm)
27
-Other points -10 of cases, the knee joint
communicates with the proximal tibiofibular
joint -pes anserinus bursa a symptomatic
wire
28
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

41
Complications
  • Subchondral collapse
  • Technical errors
  • Poor Fx reduction
  • Wrong wires
  • Wrong frame
  • Instability
  • Patient compliance

42
Conclusions
  • It is up to you
  • In our hands the best results are with closed
    reduction and Ilizarov frame application
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