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