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Arthroscopic Assisted Tibial Plateau Fracture Open Reduction Internal Fixation

February 10, 2018

Contributors: Amos Dai, BS; Rivka Chinyere Ihejirika, MD; Laith M Jazrawi, MD; Michael A Zacchilli, MD; Dylan Lowe, MD; Dylan Lowe, MD

Purpose: Tibial plateau fractures are devastating injuries leading to restricted joint motion, knee instability, pain, and early arthritis. These injuries comprise 1% of all fracture types and are often complicated by meniscal or ligamentous injury. The Schatzker classification system provides a guide for understanding the injury mechanism, severity, and need for operative fixation. In the past, severe tibial plateau fractures were treated with large exposures, periosteal stripping, and numerous plates. In modern day, an attempt has been made to avoid periosteal stripping and introduce minimally invasive, percutaneous methods of fracture fixation. In “split-depression” types, there is a trend to use arthroscopy to visualize the articular surface while the depressed bone is tamped up from a cortical window below the joint in an attempt to preserve soft tissue and blood supply to the zone of injury.

Methods: In this video we present the case of a 27-year-old male who fell 10ft while snowboarding onto his flexed left knee and sustained a type II tibial plateau fracture. We review the classification and operative indications for tibial plateau fractures and demonstrate a minimally invasive method to treating a Schatzker II fracture. We use an arthroscopic approach to visualize the joint. Medial and lateral meniscus tears are seen and debrided. Lateral articular depression is visualized arthroscopically and the chondral surface is restored through a cortical window using a bone tamp. This area is backfilled with resorbable calcium phosphate cement and the fracture is stabilized with two 6.5mm screws.

Results: Following the procedure, the patient is kept non-weight-bearing with active range of motion for 6-8 weeks. At eight weeks, he has a range of motion from 0-115 degrees and minimal pain with ambulation. Radiographs depict a healed fracture with a smooth chondral surface.

Conclusions: Schatzker II tibial plateau fractures can be treated successfully through a minimally invasive approach. Arthroscopic visualization gives a direct view of the chondral surface and is favored over intraoperative radiographs for establishing adequate restoration of the articular surface.

Results for "Knee"

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