- Indirect Reduction Stratedgy:
- statedgy forgoes attempts at meniscal reduction (or repair), ligamentous repair,
or direct joint reduction;
- longitudinal traction is used to align proximal tibial condyles over shaft;
- depressed fragments are reduced w/ a bone tamp thru cortical window;
- frx reduction is maintained w/ percutaneously appliede tenaculum clamp;
- note that flouroscopy may under-estimate joint incongruity as compared to
postop plain radiographs;
- 6.5 cannulated screws are inserted percutaneously to hold reduction;
- these are placed immediately under the subchondral surface;
-
EBI fixator (see:
external fixators)
- applied anteromedially;
- two or three cancellous screws are placed in proximal tibia;
- pins should be placed at least 1 cm away from the joint surface
but joint sepsis can occur w/ pins placed even 3 cm from
joint (due to joint capsule disruption);
- other option is to place pins in distal femur (anteromedially);
which then requires a second operation for pin insertion
into the proximal tibia at a later date;
- three cortical screws are placed distally;
- post-op, it is essential to rule out proximal pin site infections which can
lead to septic arthritis;
- dynamization of Ex-fix is carried out at 4-8 weeks;
