Platu fx

1. IN THE NAME OF GOD

2. CASE PRESENTATION
 A 34 years old man
 CTMA trauma
 Lt tibial plateau FX
 Sensory & motor normal
 Pulse normal
 No Compartment syndrome

3. CASE PRESENTATION

4. MECHANISMS
 In middle-aged or elderly patients, simple falls lead most commonly
to lateral-side fracture patterns.
 Split depression fractures of the lateral plateau are most common
 Higher speed injuries in younger patients from sports or similar
mechanism can cause split fractures or rim avulsion fractures

5.  A combination of valgus and axial compression
produces lateralside depression, split depression, or
less commonly, lateral split or total lateral condyle
fractures (the classic “bumper fracture”). Younger
patients with good bone tend to have split fractures with
less depression and elderly patients with osteopenic
bone have a greater component of compression with a
less prominent split fragmen
 he intact medial collateral ligament (MCL) acts like a
hinge for the lateral femoral
 A posteromedial shearing fracture The mechanism has
been described as knee flexion, varus, and internal
rotation of the medial
femoral condyle.13

6. MECHANISM

7. INJURIES ASSOCIATED WITH TIBIAL PLATEAU
FRACTURES
 Knee dislocation : Schatzker type IV patterns
 Compartment syndrome .acl injury. Poor prognose
 Ligament injury : Schatzker type IV, V, and VI
 High-energy : small risk of vascular injury and a high risk for
compartment syndrome
 pathognomonic of cruciate ligament injury :
 Segond fracture
 reverse Segond fracture,
 anteromedial tibial margin fractures,
 semimembranosus tendon insertion site fractures

8. IMAGING
 Standard examinations :
 Anteroposterior (AP), lateral, and an AP view in the plane of the plateau (10-
to 15-degree caudal view)
 The caudal view :
 Better view of the articular surface
 Assess displacement and depression better than the standard AP view
 Overestimate anterior displacement and depression
 oblique views are obtained to assess the location of fracture lines or degree
of displacemen When there is substantial fracture displacement, particularly
in bicondylar or fracture-dislocation patterns, radiographs in traction will better
assesst hefracture anatomy
 CT scan typically demonstrates more articular displacement and
comminution
 MRI is more sensitive at detecting ligamentous and meniscal injuries

9. CLASSIFICATION OF TIBIAL PLATEAU FRACTURES

10. CLASSIFICATION OF TIBIAL PLATEAU FRACTURES
 Schatzker Classification

11. CLASSIFICATION OF TIBIAL PLATEAU FRACTURES
 Luo Three-Column Classification

12. CLASSIFICATION OF TIBIAL PLATEAU FRACTURES
 Classification of Hohl and Moore

14. TYPE1
 involves the medial plateau
 Nonoperative treatment in undisplaced and
 stable fractures is a reasonable option with a cast in
extension; generally, early ROM is
 encouraged and weight-bearing is begun in 8 to 10
weeks

15. TYPE2
 hese injuries are associated with a
 high incidence of collateral ligament injury of the
opposite side in about 50% of patients. The
 incidence of neurovascular injury with this fracture
pattern is 12%

16. TYPE V: FOUR-PART FRACTURE
 These constitute 10% of all fracture-dislocations

17. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
 Nonoperative Treatment of Tibial Plateau Fractures

18.  Most patients with nonoperatively treated tibial
plateau fractures should be kept nonweightbearing
during the initial weeks after injury. The duration of
nonweight-bearing depends on
the fracture pattern but is typically 4 to 8 weeks

19. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
 Operative Treatment of Tibial Plateau Fractures
 indicated for displaced unstable tibial plateau fractures
 In young healthy patients : almost all bicondylar and shaft
dissociated patterns
 Surgical management was indicated if patients had more than 2 mm
articular incongruence, open fracture ,fibular head fracture greater
than 5 mm of condylar widening, over 5 degrees of varus-valgus
instability on physical examination, minimal or no preexisting
osteoarthritis of the knee, and were medically stable
toundergosurgicalintervention

20. PROGNOSE
 most studies, the fracture pattern has an effect on
patient outcome. In one study, medial
condylar fractures and bicondylar fractures with a
medial tilt were found to have less
favorable results than lateral-side patterns, and
varus was more poorly tolerated than
fibula fracture was a poor
prognostic sign Another study showed better results
in unicondylar than bicondylar
fractures

21.  lateral meniscus (91%) most commonly followed by
ACL (77%), posterolateral corner4267
 (68%), and medial meniscus (44%)
 Mcl –non operative

22. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
 Principles of Plates and Screw Fixation :
 The simplest implants : lag screws >> 6.5-mm screws work well for
major plateau fracture lines although smaller screws may work
equally well
 rafting screws :
 3.5-mm implants are less bulky and easier to fit on the bone and the
smaller 3.5-mm screws allow more screws to be placed closer to the
articular surface to support reduced fragments.
 Multiple holes in the head of the plate allow 3.5-mm screws to be
placed parallel and close to the articular surface to support the
reduced articular surface and minimize the chances for postoperative
settling

23. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
 Principles of Plates and Screw Fixation :
 Lateral plates used for bicondylar and Schatzker type VI fractures
must resist axial, rotational, and bending forces.
 Principles of External Fixation :
 Definitive external fixation still has a role in complex tibial plateau
fractures based on:
surgeon preference or in cases with severe soft tissue injury,
when despite delay, internal fixation is not felt to be safe

24. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
 Principles of External Fixation :
 The use of a fine wire external fixator in conjunction with limited-
access internal fixation provides similar stability to ORIF, but with
fewer complications.
 patients treated with a fine wire fixator are generally allowed to be
weight-bearing as tolerated very early in the postoperative period

25. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES

26. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
 Most data indicate that external fixation is equally as effective or
more so than plate fixation.
 When applying an external fixator for initial stabilization, care is taken
to avoid placement of fixator pins in area of proposed plate
placement as there is theoretical risk of infection associated with pin
sites.
 A standard of care for treatment of complex bicondylar fracture
patterns
 External fixator application is not recommended for lateral
unicondylar (Schatzker types I, II, and III) fracture patterns, unless
there is significant soft tissue compromise or in case of open
fractures, as these are length stable due to an intact medial column.

27. COMPLICATIONS
 Loss of reduction
 Wound breakdown and infection
 Septic arthritis after external fixation
 Knee stiffness
 Prominent or painful hardware
 Nonunion or delayed union
 Posttraumatic arthritis

28. APPROACH
 Antrolatral approach
 Postromedial approach
 Posterior approach+fibular osteotomy
 Extensil eapproch dead bone sandwich

32. CASE PRESENTATION
 A 34 years old man
 CTMA trauma
 Lt tibial plateau FX
 Sensory & motor normal
 Pulse normal
 No Compartment syndrome

34. CASE PRESENTATION

35. CASE PRESENTATION