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Tibial Plateau Fractures

Tibial Plateau Fractures. Roman Schwartsman M.D. Las Vegas Nevada. Classification - AO. Classification - Schatzker. Why Ilizarov?. Biomechanical advantage 4 wires & a screw are as strong as two plates (T. Watson) Fibular head wire will increase stability up to 30 %. Indications. Open Fx

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Tibial Plateau Fractures

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  1. Tibial Plateau Fractures Roman Schwartsman M.D. Las Vegas Nevada

  2. Classification - AO

  3. Classification - Schatzker

  4. Why Ilizarov?

  5. Biomechanical advantage4 wires & a screw are as strong as two plates(T. Watson)Fibular head wire will increase stability up to 30%

  6. Indications • Open Fx • Degloving injury • Compromised skin • Severe comminution • Shaft extension

  7. Objectives • Joint congruity • Axial alignment • Stable fixation • Functional ROM & WB • Soft tissue healing

  8. Pre-op evaluation • Skin & soft tissues • Radiographs • CT scan

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

  10. Fracture reduction • Skeletal traction • Closed reduction • Percutaneous reduction • Open reduction

  11. Reduction first(or possibility of reduction)- Articular surface- Metaphysis, ShaftFrame applicationafter

  12. Tibial plateauMedial Lateral Larger Smaller Stronger Weaker Higher Lower Concave Convex Meniscus small Meniscus large

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

  14. 3 1 4 2 Drop wire 2 MedialFx.

  15. 1 4 Drop wire 2 3 Anterolateral Fx.

  16. Push wire

  17. 5 3 4 1 2 Coronal split - reduce the split first

  18. Pull wire Drop wire Bicondylar comminution with pull wire to avoid clustering on the ring

  19. Safe wire placement(JOT May 1999 Thomas A.DeCoster et al )-safe corridors for wire placement-extent of capsular attachment

  20. Capsular attachment Zone I - less than 6mmZone II - up to 12 mmZone III - up to 30 mmZone IV-12mm (8-14 mm)

  21. -Other points: -10% of cases, the knee joint communicates with the proximal tibiofibular joint -pes anserinus bursa: a symptomatic wire

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

  23. Complications • Fx. related • Surgeon related • Patient related

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

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

  26. Thank you! LasVegasOrtho.com

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