Tibial plateau agf

TIBIAL PLATEAU TIBIAL PLATEAU FRACTURESFRACTURES

Angga Fiandana

Surgical Anatomy

Surgical Anatomy

Mode of injury

Varus or valgus force combined with axial loading

ClassificationSCHATZKERHOHL AND MOORE

Classification : SCHATZKER

Classification : HOHL AND MOORE

TreatmentNon OperativeOperative

Treatment : Goals

1. restoration of articular congruity, 2. axial alignment, 3. joint stability, 4. functional motion.

Treatment : OperativeThe absolute indications : 1. open tibial plateau fracture 2. a tibial plateau fracture combined with

vascular lesion.

The relative indications :1. most displaced bicondylar fractures2. displaced medial condylar fractures 3. lateral plateau fractures that result in joint

instability.

PrognosisFour primary factors determine the

prognosis 1. the degree of articular depression; 2. the extent and separation of the

condylar fracture lines; 3. the degree of diaphyseal-metaphyseal

comminution and dissociation 4. the integrity of the soft tissue envelope

Treatment : Operative

Treatment : Operative

Fixation :1. External Fixator2. Screw3. Plate : L plate or T plate4. K wire

SURGICAL TECHNIQUE

Positioning

Surgical Approach

Surgical Approach

Anterolateral approach Anteromedial approach Universal Approach Posterior Approach

Anterolateral Approach

Surgical Approacho The flaps that are raised must be full

thickness, consisting of the subcutaneous fat down to the fascia.

o The meniscus must be preserved and should never be excised to facilitate exposure. Submeniscal arthrotomy should be performed to gain visualization of the articular component

o Bone graft should be considered for depressed fracture

Postoperative Care Position : elevated limb Movement : as soon as possible Non weight bearing for 10 – 12

weeks X ray monitoring : after 6, 10, 16

weeks, and prior to implant removal Plate removal 12 – 18 months

Complication Early : compartment syndrome Late :

1. Joint stiffness2. Deformity3. Osteoarthritis

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