Treatment Options for Tibial Plateau Fractures
Treatment Options for Tibial Plateau Fractures
Treatment Options for Tibial Plateau Fractures
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Advances in technique<strong>for</strong> tibial plateau fracturesPhilip F. Stahel, MD, FACSDepartment of OrthopaedicsDenver Health Medical Center
Standard technique• Anterolateral arthrotomy
Standard technique• Submeniscal window• Open reduction• Bone grafting
Standard technique• Lateral buttress plating
Standard technique
Standard technique
Pitfalls?
Pitfalls• Malunion• Nonunion• AVN• Arthritis
Pitfall: Loss of reductionWhy do conventionalimplants fail?
Principles of standard plates
“You cannot per<strong>for</strong>m anosteosynthesis in molluscs!”(Otmar Trentz, Zürich)
High load to the implant !
The answer:Angular stability !
“Locked Internal Fixator” principle:Threaded screw headThreaded plate hole
3 months f/u
More pitfalls?
Pitfall: Inadequate approaches
Unsolved problem:Posteromedial fracture-dislocation(Moore type I & II)
Stahel et al., J. Orthop. Trauma 2008, 22:504-5.
• Bicondylar tibial plateau Fx, AO type C• n=170 (05/2000-03/2003)• 74% with postero-medial fragment (CT)Barei et al., J. Orthop. Trauma 2008, 22:176-82.
Barei et al., J. Orthop. Trauma 2008, 22:176-82.
The solution: Direct posterior approach
The solution: Direct posterior approachFakler et al., J. Orthop. Trauma 2007, 21:330-6.
The solution: Direct posterior approach• Prone position• Minimal soft tissue dissectionmedial• Interval betweensemimembranosusand medial gastrocnemiuslateral• Partial subperiostealdetachment of popliteus
Moore type IIFx-dislocation
So what?
Paradigm shift?
Hahnhaussen et al., Orthopedics 2012,35:768-72.
Percutaneous kyphoplasty
“True” percutaneous technique
Inflation osteoplasty:Is failure possible?
Learningcurve?
Errors in technique...
... vs. errors in judgment...
Mauffrey et al., Patient Saf. Surg. 2013,7:8.
Intraoperative complication rate:65% !!!
Most frequent technical complication:
Intraarticular calciumphosphateextrusion!
Beware of the “trap door” effect!
Beware of the “trap door” effect!
Case example:38-yom, three weeks after injury
Contraindication:Posterior wall fragment!
A fool witha tool is stilla fool!
Does anybody haveany questions <strong>for</strong>my answers ?Henry Kissinger
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