Executive Editor: Ernst Raaymakers, Joseph Schatzker, Rick Buckley

Authors: Matthias Hansen, Rodrigo Pesantez

Proximal tibia Partial articular fracture, split

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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.

Make sure the lateral meniscus is not caught in the fracture line

2 Patient preparation and approach top

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Patient preparation

This procedure is normally performed with the patient in a supine position.


Approach

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 top

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Single clamp

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.


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Multiple clamps

Depending on the fracture configuration more than one clamp may be necessary as shown in the image.


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Secure reduction with K-wire

Apply a K-wire to secure the reduction and to facilitate cannulated screw fixation.

4 Fixation top

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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.

v2.0 2010-05-15