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The first 25 slides, exactly as they appear. The full deck has 122 content slides.
Orthopaedics
Tibial Plateau Fractures
Built from Tang — Orthopaedic Trauma Vol 2: Lower Extremity
What’s inside
11 sections · 122 slides
Overview
- What this deck will teach you
Foundations
The knee anatomy every plateau operation must respect
- What exactly is the tibial plateau?
- How common are they?
- Company these fractures keep
- Bony anatomy of the tibial plateau
- Why the plateau fractures so readily
- Lateral vs medial condyle: not a mirror image
- The intercondylar eminence: the central anchor
- Key angles of the tibial plateau
- Two angles the surgeon must restore
- Surface landmarks that guide every incision
- How the knee stays stable: the three-layer idea
- Medial stabilising structures of the knee
- The medial side in detail
- Lateral stabilising structures of the knee
- The lateral side in detail
- The cruciate ligaments and knee rotation
- The cruciate ligaments: the knee's internal crossbraces
- How cruciates and collaterals work as a team
- The menisci and how they move
- Meniscal attachments and the capsule safe zone
- The menisci: the knee's shock absorbers
- Blood supply around the knee
- Vessels and nerves at risk
Mechanism of injury
What breaks the plateau, and what breaks with it
- A bone-and-soft-tissue injury
- High-energy versus low-energy injuries
- The force patterns that shape the fracture
Classification
Two systems that turn a fracture picture into a surgical plan
- Schatzker classification of tibial plateau fractures
- The six Schatzker types side by side
- The Schatzker classification
- Reading the Schatzker ladder
- AO-OTA classification of proximal tibial fractures
- The AO-OTA system: sorting by joint involvement
Assessment
Read the soft tissues and the joint before planning surgery
- The clinical exam: soft tissue first
- Three exams not to miss
- Plain radiographs and the plateau view
- X-ray: the first look
- CT of a tibial plateau fracture
- CT: the surgical roadmap
- MRI sectional anatomy of the injured knee
- MRI showing ligament and meniscal injury
- MRI, ultrasound and the ankle-brachial index
Principles of surgical treatment
When to operate, when to wait, and the goals of fixation
- Who needs surgery, and how urgently
- Staged treatment for a fragile soft tissue envelope
- Timing: let the skin decide
- Staged surgery: the two acts in detail
- The four goals distilled
- Matching the strategy to the Schatzker type
External fixation technique
Temporary knee-spanning frames and definitive hybrid fixators
- Schanz screw placement for a knee-spanning fixator
- Temporary knee-spanning external fixation
- Four tricks to make an external frame stiffer
- Reduction and fixation of the intra-articular fracture
- Hybrid fixator: reducing the joint first
- Placing wires for a circular external fixation frame
- Building the circular frame construct
- The circular frame: staying in the safe zone
- A hybrid-fixed Schatzker type VI fracture
- After external fixation: closing and rehabilitating
Approaches to the plateau
Positioning and the incisions that reach each fragment
- Positioning for open plateau surgery
- Setup for open reduction and internal fixation
- Anterolateral incision
- Posteromedial incision
- Combined approaches to the plateau
- The menu of surgical approaches
- Anterolateral exposure of the plateau
- The anterolateral approach step by step
- Posteromedial exposure of the plateau
- The posteromedial approach step by step
- Adding a lateral parapatellar window
- Why add a lateral parapatellar window?
Fixation by fracture type
Type-specific tactics from Schatzker I to VI
- Schatzker type I: percutaneous lag screws
- Schatzker type I: before and after
- Schatzker type I: the pure lateral split
- Schatzker type II: cortical window and elevation
- Schatzker type II: split plus depression
- Schatzker type III: opening-book reduction
- Schatzker type III: reduction and plating result
- Schatzker type III: central compression
- Schatzker type IV with knee dislocation
- Schatzker type IV: combined approach fixation
- Schatzker type IV: postoperative result
- Schatzker type IV: the dangerous medial fracture
- Schatzker type IV with meniscus intercalation
- Treating the soft tissues with the fracture
- Reduction sequence for a bicondylar fracture
- Schatzker V and VI: reducing both plateaus
- Plate selection and screw placement principles
- Bilateral plating of a Schatzker type VI fracture
- Choosing the fixation construct
- Severe Schatzker type VI with soft tissue damage
- Percutaneous plating outcome in a crush injury
- Closing the wound, and hard-won lessons
Complications and prevention
Infection, malunion, and fixation failure
- Managing wound infection after plating
- Infection: prevention beats treatment
- Posterior locking plate for coronal fractures
- Failed fixation and malunion
- Malreduction from an inadequate exposure
- Why plateau width was lost
- Choosing implants by side and bone quality
- Double plating a bicondylar fracture
- Bicondylar fixation: when one plate is not enough
Key takeaways
What to carry away from tibial plateau fractures
- The essentials in one view
- Why does a Schatzker type IV or a coronal posteromedial fracture resist a single lateral locking plate?
- References (1/7)
- References (2/7)
- References (3/7)
- References (4/7)
- References (5/7)
- References (6/7)
- References (7/7)
- Orthopaedic Trauma Surgery - Volume 2: Lower Extremity