Arthroscopic Technique for Treatment of Schatzker Type III Tibia Plateau Fractures Without Fluoroscopy

Abstract

Accurate reduction and maintenance of the stability with correct implant positioning is critical for surgical treatment of tibial plateau fractures. Our technique includes an arthroscopic reduction and fixation of Schatzker type III tibial plateau fractures with a bulls-eye screw placement without fluoroscopy control. With the arthroscopic guidance, an anterior cruciate ligament drill guide is placed and a K-wire sent to the midpoint of the depressed fragment through the guide at a 40 angle to the coronal axis of the tibia. A tunnel is created with the drill over the K-wire. The depressed fragment is further augmented with gentle impacts over the K-wire. After arthroscopic reduction control, an appropriatesized iliac graft is pushed until it is below the depressed fragment. The targeting device is adjusted at 130 so that it is parallel to the joint line and a K-wire sent through the device so that it would pass just below the graft. The graft is then supported with cannulated screws sent over the K-wire. This technique provides an arthroscopic reduction of the chondral surface and precise placement of the rafting screws without fluoroscopy.L ong-term clinical results of tibial plate fractures are dependent on the quality of the intra-articular reduction of the articular surface. 1 Excessive dissection of the injured soft tissue envelope and devitalization of bone fragments are the primary concerns of the open techniques. To eliminate the problems related to the open techniques, many authors recommended minimally invasive reduction and stabilization techniques such as isolated lateral plating with medial external fixation, hybrid external fixation, tensionedwire fixation, and percutaneous reduction. [2][3][4] In Schatzker type III tibia plateau fractures, exploration of the fracture site is challenging because the lateral plateau is not displaced. Arthroscopic reduction and internal fixation are recommended as a safe and reliable method for treatment of tibia plateau fractures. 4 With arthroscopic-assisted techniques, the reduction of the depressed fragment can be performed indirectly without excessive dissection.Inherent advantages of arthroscopic-assisted techniques include less soft tissue stripping and lesser wound site complications. To avoid these complications, arthroscopic-assisted techniques that involve restoration of the depressed joint surface and grafting under the

All-Arthroscopic Treatment of Schatzker Type III Lateral Tibial Plateau Fracture Without Fluoroscopy

“…Some specific features differentiate our technique from other arthroscopic procedures. First, most of them require drilling a canal in the proximal tibia and using a K-wire, a bone tamp, or an inflatable balloon for fracture reduction and correction of the articular depression of the posterolateral tibial plateau 3, 6, 7, 8. This technique makes the fracture reduction possible only when the special anterior cruciate ligament aiming guide is available and has a risk of iatrogenic articular cartilage lesions and displacement of the fracture fragment into the joint 11 .…”

“…Another advantage of the current presented technique is that precise fracture reduction can be achieved without using fluoroscopy, which eliminates the risk of radiation exposure. It is of benefit not only for the patient, but also for the medical staff working in the operating room 8 …”

“…Moreover, they usually provide for a suboptimal visualization of the posterior column of the tibia, what makes the proper identification, reduction, and stabilization of the fragment difficult, especially in case of Schatzker type III fractures 5 . For this specific articular depression of the lateral tibial plateau, arthroscopy-assisted surgeries were developed 3, 6, 7, 8. They allow one to avoid a majority of the limitations and risks of open surgeries, but most of them require fluoroscopy and hardware placement for fracture reduction and fixation.…”

Minimally Invasive Surgery of Tibial Plateau Fractures Reduces Incision-Healing Complications of Open Reduction and Internal Fixation

“…Many authors have recommended arthroscopyassisted techniques and external fixator applications (3,(15)(16)(17)(18). Each of these techniques has its limitations, such as need for special equipments and experience.…”

Advances in Surgical Management of Schatzker III Tibial Plateau Fractures

“…These early studies showed a low incidence of complications and satisfactory clinical and radiological results. (6)(7)(8)(9) A thorough understanding of the clinical and imaging anatomy of the tibial plateau and the tibial plateau is essential when trying to perform less invasive surgery on intraarticular plateau fractures. All these new technologies have achieved good clinical results.…”