Metaphyseal tibial level (MTL) screws: a modified percutaneous technique for lateral plateau depression fractures

Abstract

The combination of subchondral screws in a jail technique with a bioabsorbable interference screw that we named metaphyseal tibia level (MTL) screw technique is, to our knowledge, not described. The MTL screw promises to be a true percutaneous reduction and fixation technique for Schatzker II and III fractures in patients with reasonable bone quality.

Influence of screw to joint distance on articular subsidence in tibial‐plateau fractures

“…[3][4][5][6] We propose that the common unifying principle behind many of these techniques is the provision of mechanical support close to the joint linea variable that can be quantified as the 'SJD'. 1,2 Numerous techniques have been described as a means of overcoming this problem, with the most readily available and cost effective being the 'strategic' positioning of implants such as the use of mini-fragment rim plates, peri-articular K wires, 'jail screws', 'MTL screws' and 'magic screws'.…”

“…1,2 Numerous techniques have been described as a means of overcoming this problem, with the most readily available and cost effective being the 'strategic' positioning of implants such as the use of mini-fragment rim plates, peri-articular K wires, 'jail screws', 'MTL screws' and 'magic screws'. [3][4][5][6] We propose that the common unifying principle behind many of these techniques is the provision of mechanical support close to the joint linea variable that can be quantified as the 'SJD'.…”

A Novel Percutaneous Screw Fixation of Postero-lateral Tibial Plateau Fracture using Posterior Cruciate Ligament Reconstruction Femoral Template: Technical Note

“…As reflected from the preoperative CT scans, medial tibia plating to fix the posterolateral corner of tibia plateau was not ideal as the screw purchase is poor. 2 We believed that the posterolateral tibial plateau fracture, particularly with a small fracture fragment, is unique in surgical planning and execution with regard to its special anatomical considerations. We needed to minimise the risk of damaging the fibular nerve as the fracture was exactly medial and in close proximity to the fibular head region.…”

“…It was important to have a good aiming device that could provide a good trajectory and avoid perforating the posterolateral corner and avoid fibular structures. 2 Besides, we had to find ways to achieve good implant bone purchase, stable fixation, a safe metaphyseal corridor for instrumental manual elevation of the depressed bone fragment, and allow adequate bone substitute impaction to maintain the reduction. 1 These considerations are especially important in osteoporotic patients.…”

“…3 Types IeIII are the most commonly associated with lower-to middle-energy trauma involving the lateral plateau with type II being the most frequent subtype. 2 Managing tibial plateau fractures in osteoporotic patients can be very challenging with the need to address adequate grafting of the bone defect, restoring the anatomic joint congruency, and ensuring a stable fracture fixation. Percutaneous treatment of this type of fracture can be performed using arthroscopy as well as image intensification to achieve reduction of the joint surface.…”