2. Tn. Romeo 30 tahun,saat ini sedang diberikan anastesi
sebelum dilakukan double plating di proximal tibianya. Romeo
didiagnosa mengalami fraktur berdasarkan hasil xray berikut
3.
4. Depend on the result, the Doctor should know about :
• X- ray reading and AO Classification
• Anatomy (Bone,Joint, Muscle,Neurovascular)
• Apa saja jenis fracture di proximal tibia menurut AO
• Jelaskan klasifikasi fraktur proximal tibia menurut skhatzker ?
• Jelaskan tentang system LISS? Apa alas an dokter memilih LISS ?
• Jelaskan tentang double plating ? Syarat apa saja yang harus dipenuhi untuk
melakukan double plating serta plate apa yang digunakan ?
• Apa saja ukuran LCP Plate yang ada di Ware House TMIDN ?
• Jelaskan mengenai rafting technique ? Apa indikasi dan plate apa yang
digunakannya ?
6. 1. X- ray reading and AO Classification
View : Lateral
Side : Kanan
Joint : Knee
Bone : distal femur, proxi tibia,fibula
intra intra articular
Lokasi dilateral dan medial
11. Jenis fraktur di Proximal Tibia menurut AO
•Extraarticular
Avulsion Metaphyseal Simple Metaphyseal
Fibular head
Wedge/Multifragmentary
Tibial tubercle
Tibial spine or
capsular attachments
15. The Schatzker classification is divided into six types:
• Type 1: Lateral plateau fracture without depression
• Type 2: Lateral plateau fracture with depression
• Type 3: Compression fracture of the lateral (type 3 A) or central
(type 3B) plateau
• Type 4: Medial plateau fracture
• Type 5: Icondylar plateau fracture
• Type 6: Plateau fracture with diaphyseal discontinuity
16. DOUBLE PLATING
Syarat Menggunakan Double Platting :
• patahan nya di bagian bicondylar atau schatzker V dan VI.
• Posisi plate harus saling berhadapan
• Panjang plate harus berbeda salah satu
• Pemasangan screw tidak boleh bertabrakan
Complete articular fracture, simple articular, multifragmentary metaphyseal
Plat yang digunkan untuk Double Plating iyalah :
LCP Plate
LC DCP Plate
Teknik ini digunakan ketika keuntungan biomekanik dari pelat tunggal tidak ideal. Pelat ganda,
dengan pelat medial dan lateral, memberikan lebih banyak stabilitas biomekanik di mana pola
fraktur mulfragmenter,
terutama dengan adanya osteoporosis, membuat stabilitas menjadi tantangan. Strateginya mirip
dengan jenis fiksasi lain di mana blok artikular masih harus direkonstruksi tetapi dua pelat
digunakan untuk mempertahankan reduksi antara segmen ujung proksimal dan distal. Ini adalah
konstruksi pelat jembatan. Dalam kasus osteoporosis, fiksasi penguncian hampir selalu digunakan.
Karena sebagian besar ahli bedah memiliki lebih banyak pengalaman dalam fiksasi pelat lateral
(dibandingkan dengan fiksasi medial), sebagian besar ahli bedah akan melakukan reduksi dan
fiksasi pelat pada sisi lateral terlebih dahulu.
20. RAFTING TECHNIQUE
The rafting screw technique management of lateral tibial plateau fractures with articular
depression.
To gain access to the depressed articular fragments, the split fragment is hinged open laterally. We
elevate the depressed articular fragments to the normal level. The defect below is filled with bone
graft or its substitutes. We then close the split fragment and apply rafting screws either through the
screw holes of the plate or separately above the plate rather in a blind fashion. We therefore cannot
be sure that the rafting screws are supporting the specific elevated fragments. For this reason some
surgeons place the rafting screws from within and then close the lateral fragment over the screws.
This so-called embedded rafting screw technique carries the risk of difficulty in removal, especially
in case of an infection. Here we describe the inside out rafting technique to tackle this problem.
PLATE YANG DIGUNAKAN
LCP PROXIMAL LATERAL TIBIAL ( LISS )
LCP PROXIMA MEDIAL TIBAI 3.5
LCP PROXIMAL TIBIAL 3.5, 4,5 DAN 5,0
21. Indiction of Rafting technique
• Split
• Split Depression
• Depression
Atau Schatzker 1 s/d 3
22. LCP PROXIMAL TIBIA PLATE 4.5
INDICATIONS
• Simple, comminuted fractures
• x Lateral wedge fractures
• x Depression medial wedge fractures
• x Bicondylar combination of lateral wedge and depression fractures
• x Periprosthetic fractures
• x Proximal fractures with associated shaft fractures
23. LCP PROXIMAL TIBIA PLATE 3.5
INDICTIONS
• Split-type fractures of the lateral tibial plateau
• Lateral split fractures with associated depressions
• Pure central depression fractures
• Split or depression fractures of the medial plateau
24. PERBEDAAN LCP PROXIMAL TIBIAL 3.5 DAN 4.5
NO
LCP PROXI
TIBIAL 3.5
the plate head accept Locking Screw B
3.5 mm (Stardrive or hexagonal) or
Cortex Screw B 3.5 mm or Shaft Screw
B 3.5 mm to secure plate position.
The combi-holes accept Locking Screw B 3.5 mm
(Stardrive or hexagonal) or Cortex Screw B 3.5 mm or
Shaft Screw B 3.5 mm in the threaded portion of the
hole and Locking Screw B 3.5 mm (Stardrive or
hexagonal) or Cortex Screw B 3.5 mm or Shaft Screw B
3.5 mm in the DCU portion of the hole.
Available in left and right plates, in
implant quality 316L stainless steel or
pure Titanium (TiCP).
Available with 4, 6, 8, 10, 12, 14, or 16 screw holes.
LCP PROXI
TIBIAL 4.5
head accept 4.5 mm cortex screws
and 6.5 mm cancellous bone screws
Combi holes accept 4.0 mm or 5.0 mm locking screws
in the threaded portion or 4.5 mm cortex screws in
the DCU portion
Three locking screw holes accept 5.0
mm cannulated locking or 5.0 mm
cannulated conical screws
Available with 4, 6, 8, 10, 12, 14, 16*, 18*, or 20*
Combi holes in the plate shaft
Plates with 16, 18, or 20 screw holes are only
available in 316L stainless steel.
28. LCP PLT and LISS PLT are indicated
for the stabilization of fractures of the proximal tibia. These include:
• Proximal shaft fractures
• Metaphyseal fractures
• Intra-articular fractures
• Periprosthetic fractures
