- Discussion:
- bicondylar frx w/ distal oblique shaft frx;
- these frx have bicondylar frx along w/ dissociation of diaphysis from metaphysis;
- if the medial plateau fragment is intact, this frx can be treated with placement of a lateral plate and and Ex Fix to prevent displacement;
- 35% of type VI fractures are open and 86% has extensive soft tissue injuries;
- Management:
- spanning fixators:
-
Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol.
-
Compartment syndrome in Schatzker type VI plateau fractures and medial condylar fracture-dislocations treated with temporary external fixation.
-
circular wire fixators:
- can be used to stabilize the diaphyseal-metaphyseal segment;
- circular wire fixators are unable to reliably stabilize the articular surface;
- articular fixation requires either lateral plating or insertion of cancellous lag screws inserted over washers;
- this fixation should precede application of the fixator;
- if possible screws should be inserted from lateral to medial or from anterior to posterior;
-
complications:
- pin tract infections can lead to devastating knee sepsis and therefore pins needs to be inserted at least 2 cm from the joint line;
- in the study by JS Reid et al, the authors determined in a cadaver study that proximal tibial transfixation wires away from the tib-fib joint are likely
to be extra-articular if kept greater than 14 mm away from the subchondral bone.
- in the region of tib-fib joint, safe distance is difficult to determine since it cannot be known preop which knees have torn septum;
- loss of fixation following frame removal;
- note that in complex fractures, the frame may have to be left in place for up to 3 months to ensure maturation of fracture healing (gradual
loss of reduction may occur with premature frame removal);
- references:
- Bicondylar Tibial Plateau Fractures Treated with a Hybrid Ring External Fixator: Journal of Orthopaedic Trauma. Vol 8, No 6. p 455-461.
- Safe placement of proximal tibial transfixation wires with respect to intracapsular penetration. Journal of Othopaedic Trauma. Vol 15. No 1. p 10-17.
- Indirect Reduction Stratedgy:
- Open Reduction Stratedgy:
- Post Operative Care and Compications:
External Fixation and Limited Internal Fixation for Complex Fractures of the Tibial Plateau. J.L. Marsh MD, S.T. Smith MD, and T.T. Do MD. JBJS (Am). Vol. 77-A, No. 5, May 1995.
The use of an anterior incision of the meniscus for exposure of tibial plateau fractures requiring open reduction and internal fixation.
EH Karas, LS Weiner, and EC Young. J. Orthop Trauma. Vol 10, No 4, p 243-247.
Anterior Approach to the Knee with Osteotomy of the Tibial Tubercle for Bicondylar Tibial Fractures. Fernadez DL. JBJS- Am. 70: 208, 1988.
Combined Anterior and Posterior Approaches for Complex Tibial Plateau Fractures. Geordiadis GM. JBJS (Br) 76: 285, 1994.
Treatment of Complex Tibial Plateau Fractures with the Ilizarov External Fixator. R. Buckle, R. Blake, JT Watson. J. Orthop. Trauma 7: 167, 1993.
Early Results of a New Technique for Treatment of High Grade Tibial Plateau Fractures. Christensen K, Powell J, Bucholz R. J. Orthop. Trauma 4: 226, 1990.
Internal versus External Fixation of Bicondylar Tibial Plateau Fractures. AR Mallik, DJ Covall, and GP Whielaw. Orthop. Rev. 21: 1433, 1992.
Staged management of high-energy proximal tibia fractures (OTA types 41): The results of a prospective, standardized protocol. J Orthoop Trauma 2005;19:448-455.
