Executive Editor: Ernst Raaymakers, Joseph Schatzker

Authors: Matthias Hansen, Rodrigo Pesantez

Proximal tibia 41-B1 Direct reduction

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Glossary

1 Principles top

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Anatomical reduction

Anatomical reduction of the articular fracture component and fixation with absolute stability is mandatory.

Lateral versus medial condylar fractures
The operative procedures for lateral condylar fractures (B1.1-type fractures) and medial condylar fractures (B1.2- and B1.3-type fractures) are comparable. A lateral condylar fracture treatment (B1.1-type fracture) is shown here.

Usually this fracture requires a buttress plate as simple screws may not hold the reduction as securely.

2 Reduction top

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Clamps

Indirect reduction may be attempted by external manipulation of the fractured fragment using clamps. The accuracy of reduction should be checked with an arthroscope if no arthrotomy is carried out. In cases where adequate closed reduction is not achieved the joint must be opened in order to carry out an anatomical reduction of the joint surface. This may also be necessary to repair the lateral meniscus which is often injured in association with these fractures.


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Clinical image showing the clamp application.

3 Fixation top

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Lag screw application

Once reduction of the joint fragment is obtained, two partially threaded cancellous bone screws are inserted to securely fix the fracture. In cases of good bone substance, stable fixation may be easy to obtain and no further implants are needed.

Click here for a detailed description of the lag screw technique.


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Washers

The cortex in the lateral tibial head is thin. Therefore, the use of washers is advised.

v2.0 2016-11-21