- Discussion:
- in most split frxs, large articular frag has separated in coronal plane
from posterior portion of
medial tibial plateau;
- fragment rarely separates from
lateral plateau or from anterior aspect
of either plateau;
- 22% of these frxs will also have assoc
intercondylar eminence frx;
- 21% will have a cruciate or collateral
ligament injury;
- Radiographs:
- key feature on AP view is appearance of 2 level plateau on the same side
of knee as the split fracture;
- lateral x-rays show the size and displacement of the split fragment;
- lateral x-ray made in full extension may demonstrate reduction of
fragment to a normal articular level;
- when knee is flexed,
reduction is lost as femoral
condyle subluxates with the split fragment;
- Non Operative Rx:
- if frag reduces in full extension, either long leg cast is applied, or
percutaneous pin fixation can be performed;
- w/ closed treatment, by extending knee fully, closed reduction often
succeeds in bringing articular fragment to normal articualr level;
- keeping knee in extension usually prevents
Loss of Reduction;
- Operative Treatment:
-
PreOp Planning
- operative treatment is indicated for irreducible split fractures &
those associated with
intercondylar eminence fractures;
- if frag reduces in full extension consider need for percutaneous pin fixation;
- if fragment is displcaced > 2 mm, a large Steinmann pin can be inserted into
frag to manually elevate it;
- once fragment is elevated, pin is driven in further for temporary fixation;
- cancellous screws are inserted from anterior to posterior, engaging
split fragment;
- frxs involving posteromedial aspect of tibia are approached posterior to
medial collateral ligament & and the joint is entered distal to the medial
meniscus;
- Post Operative Care and Compications:
