1 Principles topenlarge
Anatomical reduction of the articular fracture component and fixation with lag screws (absolute stability) is mandatory.
After reduction of the articular fracture component, anatomical reduction of the metaphyseal component has to be achieved.
In order to avoid varus collapse on the medial side double plating should be considered and if necessary carried out. In these fracture patterns the placement of the medial plate may be anteromedial rather than posteromedial. This depends of course on the fracture pattern and forces which have to be neutralized.
2 Reduction topenlarge
Indirect reduction may be achieved by external manipulation of the fracture fragment with clamps. In cases where adequate closed reduction is not achieved, the joint must be opened to carry out an open reduction.
If one is trying to carry out the procedure without opening the joint then reduction must be checked either with image intensification or with arthroscopy.
Pearl: clamp over plate
If you intend to keep the clamp on throughout the whole procedure it is best to slip the plate under the clamp prior to tightening the clamp to maintain reduction. Under these circumstances you determine which screw hole is best for the placement of the tip of the clamp from the pre-operative plan and intra-operative trial.
Anatomical reduction of the articular surface is mandatory. Secure reduction and provisional fixation with K-wires.
Positioning of the knee is important for correct reduction and fixation. If the knee has a valgus injury, then the knee should be held with more varus positioning to ensure a good reduction. If the knee has a varus injury (medial condyle) then valgus positioning during reduction is important.