- 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