Plating tibial plateau fractures

Modificeret af Frank Damborg. AOT Advanced Principles Course

Baseret p AO foredrag af
Cong-Feng Luo, CN
Principles for soft-tissue management

Wait for the soft tissue!!

Staged treatment if ORIF of tibial plateau

fracture
Principles for definitive fixation

Fully understand the fracture,

especially the 3-D construct

Anatomically restore the

articular surfaceno structural
articular defect

Stable fixation to maintain the

alignment
Understand the fracture

AO Classification

Schatzker classification

CT / 3-D construct
3-Column-concept.
Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010 Nov;24(11):683-92 .
3-Column classification

Column fracturebreakage of
corresponding cortex
(compression/tension fracture)

Localize the articular surface

depression

Pure depression of articular

surface (Schatzker type III)
zero column fracture
3-Column-concept.

Varus + Valgus +
extension extension

Flexion

Morphology and injury mechanism

Principles for approach selection

Biomechanics of fixation

Depressed articular
fragment

Soft-tissue tolerance
Principle for plate fixation

Buttress fixation is preferred for

column fractures

Main buttress plate is chosen

according to the injury
mechanism

Bridging is used for comminuted

metaphyseal fractures
Lateral column fracture
Valgus extension mechanism
Posterior column fracture

Flexion
mechanism

M L
Depression
Depression
Proximal
Medial column fracture
Extension varus mechanism
2 column fractures

Understanding the fracture is essential for decision

making and definitive fixation

If not too comminuted combination ORIF surgery

with 2 plates and 2 approaches are possible
Bone graft
Often needed for
articular defect

Grafting technique
can reduce the
amount of bone graft

Bone substitute can

be considered
Comminuted 2 and 3-
Column fracture

medial
Varus
flexion
mechanism posterior
 The result of ORIF for this type of injury is not satisfactory
Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS et al. Complications after tibia plateau fracture surgery. Injury. 2006 Jun;37(6):475484.
Epub 2005 Aug 22. Review
Take-home messages

Fully understanding the fracture is essential for

decision making and definitive fixation

Approach selection and fixation should take into

account the soft tissue, mechanism of injury, and
3-D morphology

3-column classification provides a way of planning

the treatment of tibial plateau fractures

ORIF and EX-fix supplements each other

Supplerende slides:

If ORIF surgery for 2 or 3 collum fx:

Approach: midline + posteriomedial
 Midline
approach

Fracture window

Posteriomedial approach
1-year
follow up
Schatzker type V, VI2 or 3-column fracture

Dual plating
3-Column fracture

Flexion varus mechanism

Floating position
A