- 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;
