1 Principles topenlarge
B2-type fractures are intraarticular, therefore they need anatomical reduction.
The plate in this procedure acts as a buttress to neutralize the axial forces on the tibial plateau and protects the weakened or fenestrated (windowed) medial cortex from failing.
Lateral versus medial condylar fractures
The operative procedures for lateral condylar fractures (B2.1- and B2.2-type fractures) and medial condylar fractures (B2.3- type fractures) are comparable. A lateral condylar fracture treatment (B2.1- and B2.2-type fracture) is shown here.
2 Reduction topenlarge
Reduction of the impacted fragment(s)
Make a window in the anterolateral cortex of the tibial condyle lateral to the tibial tuberosity and about 5 cm distal to the joint line.
Introduce a curved impactor and elevate the impacted bone until the articular fragments are reduced and the joint is congruent again. Slight overcorrection will compensate for a slight loss in height of the reduced articular fragment(s) which may occur following surgery.
The articular surface may be inspected directly through a standard submeniscal articular exposure or by means of an arthroscope inserted through a medial portal.
Temporary fixation of the elevated articular fragments with K-wires may be helpful.
Filling of defect
The defect which is created once the impacted articular fragments are reduced must be filled with an autologous cancellous autograft or a corticocancellous block graft to support the elevated fragments. Alternatively the use of bone substitutes may be considered.
3 Fixation topenlarge
K-wire fixation is useful in maintaining the articular fragments reduced until the metaphyseal defect is bone grafted.
In the purely depressed B2-type fracture, the plate acts as protection for the weakened fenestrated lateral cortex.