Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Chapter 9
- Chapter 10
- Chapter 11
- Chapter 12
- Section I Fractures of the proximal tibia
- Section II Fractures of the tibial shaft
- Section III Fractures of the distal tibia
- Chapter 13
- Chapter 14
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Section I - Fractures of the proximal tibia
from Chapter 12
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Chapter 9
- Chapter 10
- Chapter 11
- Chapter 12
- Section I Fractures of the proximal tibia
- Section II Fractures of the tibial shaft
- Section III Fractures of the distal tibia
- Chapter 13
- Chapter 14
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
OPEN REDUCTION AND INTERNAL FIXATION (ORIF) OF A LATERAL TIBIAL PLATEAU FRACTURE
Indications
Clinical: instability of the knee on valgus testing.
Radiological: split, central depression or split depression fracture types.
Joint depression > 3 mm.
Pre-operative planning
Clinical assessment
Swollen knee.
Valgus deformity common.
Common peroneal palsy possible but rare.
Compartment syndrome – possible but rare.
Radiological assessment
An anteroposterior (AP) radiograph is most useful to detect fractures and assess degree of joint depression (Fig. 12.1).
A lateral radiograph is less helpful in determining the degree of depression.
A CT scan is most useful for additional imaging-mainly indicated in cases where there is doubt about the extent or degree of depressionandincomplexfractures (Fig. 12.2a,b).
Operative treatment
Anaesthesia
General anaesthesia preferred – avoid local blocks/spinal anaesthesia which mask symptoms and signs of compartment syndrome.
Prophylactic antibiotics at induction.
Equipment
Standard AO set with reduction clamps and Kirschner wires.
Radiolucent table with ability to flex at the level of the knee.
Equipment to harvest bone graft or calcium phosphate cement.
Set up
Instrumentation on the side of the injured leg.
Image intensifier on contralateral side.
Knee flexed at 90° at the outset of the procedure to facilitate exposure (Figure 12.3a,b).
Knee brought into extension once the fracture is reduced to complete fixation.
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- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 210 - 221Publisher: Cambridge University PressPrint publication year: 2006