ORIF Tibial Plateau And Tibial Shaft

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ORIF tibial plateau and tibial shaft

– 52 year old gentleman in skiing accident; lateral split depression fracture of anterior/lateral tibial plateau, and long spiral shaft fracture with anterior butterfly extending very proximally, making the shaft un-nailable.

Surgeon: O’Brien

Positioning: Supine with tourniquet; ski-jump under leg.

Description:

Anterolateral incision at the knee, extended down the tibia just a fingerbreadth lateral to the crest to do an anterior approach to the tibia. Incise through the layers of the knee to reach the synovium, and incise the joint, releasing the hemarthrosis (be ready for the squirt of blood!). Watch out for the meniscus – look for a tear in it and maybe put a stay suture through it. Then extend the
incision distally and subperiosteally strip the lateral aspect of the anterior tibia. Beware exposing the medial side, as you want to leave that as untouched as possible.

This case was interesting because there was a huge long spiral butterfly fragment posteriorly as well, which we could not reduce – exposing it to reduce it would have devascularized it completely. We used unicortical screws through a lateral buttress plate (a DC plate with a buttress for the lateral plateau). He uses 16 mm screws for the unicorticals. We used partially threaded cancellouw screws through the buttress plate under the plateau to secure the plateau fragments.

About OrthoNet

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FUSE (Find, Use, Share, Expand) Orthopaedic Knowledge

OrthoNet strives to enable orthopaedic residents and medical students on orthopaedic rotations to Find, Use, Share and Expand practical orthopaedic knowledge.

FUSE (for Find, Use, Share, and Expand) was introduced by Yahoo! and is based on their vision for using search to fuse a myriad of services and applications, all of which center on knowledge and its application.

I really like the concept “Find, Use, Share, Expand. The potential from what it implies is huge. Be it search, learning, knowledge, or social networks most of what we do today can be summed up in this simple statement.

OrthoNet consists of hundreds of notes on core topics created during orthopaedic residency. These notes have been sitting on my computer and smart phone for years and I thought it would be useful to make this content available to everyone. I cannot take credit for all the notes, many of them have been inherited over the years from several residents. This basic content however is a small part of what I hope OrthoNet will become. Each resident has a unique training experience based on their exposure to different cases, different surgeons, and different training environments.

OrthoNet provides a unique “blogging” type of interface to allow residents and medical students to append additional information to the topic pages. You could add the surgical approach and rationale recommended by your staff or add a link to another resource which you find useful. We often share our experiences with residents in our own training programs. This sharing process promotes expansion of our own knowledge. Why not increase this sharing across training programs and expand our knowledge collaboratively using the Internet.

The OrthoNet interface is very plain and simple so you can concentrate on Finding, Using, Sharing and Expanding orthopaedic knowledge based on your experiences. The content can be accessed anywhere. The objective is to provide practical information on core topics in orthopaedic surgery at the point of care. This learning on the fly strategy works towards enhancing an educational encounter.

All residents are encourage to become regular contributors to OrthoNet. Simply submit your comments to the daily posts and core topics.

FUSE (Find, Use, Share, Expand) Orthopaedic Knowledge

Christian