26 Lateral Tibial Plateau Open Reduction Internal Fixation
Summary
Tibial plateau fractures are periarticular fractures involving the proximal tibia. These fracture patterns are common and often present in a bimodal distribution (high-energy trauma in younger population; low-energy trauma in the elderly), typically involving a varus or valgus load with or without an associated axial load. Higher energy forms of this fracture pattern should raise suspicion for soft tissue injuries (meniscus, collateral/cruciate ligaments, etc.), and external-fixation should be considered. For definitive surgical management, open reduction internal fixation is indicated with articular step-off greater than 3 mm, condylar widening greater than 5 mm, and bicondylar fracture involvement. This chapter will discuss the operative technique for open reduction internal fixation of lateral tibial plateau fractures.
26.1 Preop
Imaging available. Make sure images of fracture are available for intraoperative referencing (▶Fig. 26.1).
Surgical table. Radiolucent flat-top table
Intraop imaging. C-arm available for intraoperative imaging, best when entering field from contralateral side, perpendicular to bed (take anteroposterior and lateral of femoral neck preop).
Patient positioning. Supine with bump or foam triangle under operative knee.
If traction pin in place, can remove prior to prep and drape process.
Prep. Prep and drape entire leg through ipsilateral iliac crest.
Equipment. Specific equipment required includes periarticular clamps, Kirschner wires (K-wires), cancellous and cortical screws, and a locking femoral condylar plate.
26.2 Approach
26.2.1 Lateral Approach to Knee
Identify and mark relevant anatomy using a sterile marking pen.
Gerdy’s tubercle (insertion of IT band), tibial crest, fibular head, tibio-femoral joint line, and lateral femoral condyle
Mark out the planned incision.
Most commonly begins distally at the level of the tibial crest, then approximately 2-cm laterally to this point.
Should extend proximally and laterally over the femoral epicondyle.
Make the incision along the drawn-out incision line. Be sure to use the entire incision as appropriate visualization of the tibial plateau is paramount.
Dissect through the subcutaneous fascia to the level of the IT band as it inserts into Gerdy’s tubercle.
Splint the IT band as follows:
Dissect through the fibers longitudinally and parallel to the skin incision.
Elevate the IT band off its insertion off Gerdy’s tubercle anteriorly and posteriorly for adequate mobilization (visualization purposes).
Care must be taken to avoid disrupting the knee joint capsule.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
