Open reduction and internal fixation of posterior column tibial plateau fracture with Synthes proximal tibial LISS plate
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As with much of adult trauma tibial plateau fractures have a bimodal distribution. In younger patients these injuries result from high energy mechanisms such as falls from height or road traffic accidents whereas in the elderly population they more often result from simple falls.
Tibial plateau injuries have been classified by Schatzker, on the basis of plain film radiographs, into 6 types. Types 5 (bicondylar) and type 6 (bicondylar with complete separation of the joint surface from the tibial shaft) represent the higher energy injuries. A more recent classification by Luo, based on CT scans, divides the tibial plateau into 3 columns, medial, lateral and posterior and helps to guide the surgical approach to the fracture depending on the precise fracture configuration.
The majority of tibial plateau fractures involve the lateral side and can be approached with the standard anterolateral approach with meniscal elevation. For those fractures with medial or posterior involvement a number of further approaches are possible from direct medial, postero-medial, direct posterior or even poster-lateral. Fixation of bicondylar tibial plateau fractures via a single anterior mid-line incision is now generally avoided owing to extensive soft tissue dissection required and the consequential wound problems associated with this approach.
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Author:Mr Paul Fenton FRCS (Tr & Orth)
Institution: The Queen Elizabeth Hospital, Birmingham, UK.