1 Principles topenlarge
Anatomical reduction of the articular fracture component and fixation with absolute stability is mandatory.
Make sure the lateral meniscus is not caught in the fracture line
2 Patient preparation and approach topenlarge
This procedure is normally performed with the patient in a supine position.
In order for screws to achieve a lag or compression effect at the fracture, they must be inserted perpedicular to the fracture plane. The fracture plane therefore dictates screw entry points.
If there is concern about the proximity of major nerves, simple stab incisions should not be used, the skin should be incised followed by blunt dissection to avoid nerve damage.
3 Reduction topenlarge
Indirect reduction may be achieved by external manipulation of the fractured fragment using clamps. In cases where adequate closed reduction is not achieved the joint should be opened to allow anatomical reduction.
Check the reduction either arthroscopically or under image intensification.
Depending on the fracture configuration more than one clamp may be necessary as shown in the image.
Secure reduction with K-wire
Apply a K-wire to secure the reduction and to facilitate cannulated screw fixation.
4 Fixation topenlarge
Lag screw application
Once anatomic reduction of the fracture is obtained fixation follows with two cancellous screws with washer. In young people screw fixation is enough. In older individuals a buttress plate should be added to prevent displacement.
Use image intensification to check the length and position of the implants.
The cortex in the lateral tibial head is thin. Therefore, the use of washers is needed in the majority of the patients.
Click here for a detailed description of the lag screw technique.