- See:
- Bicondylar Fractures and Type V Fractures:
- Split Fractures:
- Surgical Approach: Medial Compartment:
- Type IV Fractures:
- Total Depression Fracture:
- X-ray:
- if knee is unstable (greater > 5 deg instability), stress x-rays are made todetermine whether the instability is secondary to movement
at frx site
or to ligament injury;
- when instability is due to a fracture movement, a cast brace is used to stabilize the leg;
- Indications for Treatment:
- medial condyle frxs although displaced or depressed only a few mm, need open reduction and internal fixation to prevent frx migration;
- this is esp true w/ intact fibula;
- lateral condyle frx of < 5 mm displacement are treated w/ traction for a few days, then cast brace until healed;
- Operative Treatment:
- PreOp Planning
- beacuse Medial Plateua fractures tend to be more unstable, consider percutaneous pin fixation or screw fixation, followed by cast brace;
- varus malunion resulting from loss of position of medial plateau fracture promotes early osteoarthritis;
- Post Operative Care and Compications:
- minimally displaced fractures of lateral plateau are stable & require little external support during healing;
- medial plateau frxs, however, whether stable or unstable, have tendency to displace, esp w/ intact fibula;
- varus deformity gradually develops after non operative treatment;
- varus malunion from resulting from loss of position of medial plateau frx promotes early development of traumatic arthritis;
- these frxs may lose position gradually during non op treatment & return to displacement that was present during traumatic incident;
- this is especially likely to occur in oblique frx that extend from region of intercondylar notch to medial or lateral tibial cortex;
- Radiographs should be obtained periodically during first few wks after injury to assure that reduction is being maintained
Posteromedial tibial plateau fractures. Operative treatment by posterior approach.