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Bicondylar Planteau Frx: Indirect Reduction


- Indirect Reduction Stratedgy:
    - statedgy forgoes attempts at meniscal reduction (or repair), ligamentous repair, or direct joint reduction;
    - longitudinal traction is used to align proximal tibial condyles over shaft;
    - depressed fragments are reduced w/ a bone tamp thru cortical window;
    - frx reduction is maintained w/ percutaneously appliede tenaculum clamp;
    - note that flouroscopy may under-estimate joint incongruity as compared to postop plain radiographs;
    - 6.5 cannulated screws are inserted percutaneously to hold reduction;
           - these are placed immediately under the subchondral surface;
    - EBI fixator (see: external fixators)
           - applied anteromedially;
           - two or three cancellous screws are placed in proximal tibia;
                 - pins should be placed at least 1 cm away from the joint surface but joint sepsis can occur w/ pins placed even 3 cm from joint 
                        (due to joint capsule disruption);
                 - other option is to place pins in distal femur (anteromedially); which then requires a second operation for pin insertion into the 
                        proximal tibia at a later date;
           - three cortical screws are placed distally;
    - post-op, it is essential to rule out proximal pin site infections which can lead to septic arthritis;
    - dynamization of Ex-fix is carried out at 4-8 weeks