The Hip: Preservation, Replacement and Revision

Total Depression Fracture

- See:
      - Medial Approach:
      - Post Operative Care and Compications:
- Discussion:
    - oblique frx that begins near intercondylar eminence & extends to cortex of medial or lateral tibial flare;
    - total depression is similar to Type IV Frx
    - TDF of medial plateau are prone to loss of position (esp w/ intact fibula)
    - medial plateau depressions of > 5 mm result in loss of nl valgus alignment or even varus alignment of the knee;
- Non Operative Treatment:
    - TDFof lateral plateau w/ < 5 mm of depression or displacement is treated w/ cast or cast brace;
          - long leg cast may not provide enough lateral support to prevent loss of frx reduction;
         - cast brace provides better support;
    - TDF of Medial Plateau:
         - w/ < 5 mm of depression or displacement, try closed reduction to bring  fracture fragment upto the normal articular level;
               - capsular attachments to displaced plateau will serve to reduce fracture when knee is placed in valgus;
- Operative Treatment:
    - PreOp Planning
    - 2 or 3 K wires with cannulated screws, for frxs of lateral plateau;
         - after percutaneous screw fixation, cast bracing is needed;
    - w/ > 5 mm displacement & an unstable knee, then butress plate is required;
         -  buttress plate is required for comminuted frxs of medial or lateral plateau;
         - T or L butress plates are contoured to shape of tibial flare w/bending irons and fixed with cancellous cortical screws;
- Post Operative Care and Compications:
    - TDF of medial plateau are prone to loss of position;
    - Loss of Reduction:
         - occurs in 20% of such frxs that were treated by closed means;
         - X-rays obtained every 14 days wil reveal any loss of position, and will allow correction of position

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, September 9, 2011 3:18 pm