Jaiswal Atin, Kachchhap Naiman-Deepak, Tanwar Yashwant S, Kumar Birendra, Yadav Sachin K
Department of Orthopaedics, Bokaro General Hospital, Bokaro, India.
Chin J Traumatol. 2014;17(3):183-6.
High-energy tibial plateau fracture poses a significant challenge and difficulty for orthopaedic surgeons. Fracture of tibial plateau involves major weight bearing joint and may alter knee kinematics. Anatomic reconstruction of the proximal tibial articular surfaces, restoration of the limb axis (limb alignment) and stable fixation permitting early joint motion are the goals of the treatment. In cases of complex bicondylar tibial plateau fractures, isolated lateral plating is frequently associated with varus malalignment and better results have been obtained with bilateral plating through dual incisions. However sometimes a complex type of bicondylar tibial plateau fractures is encountered in which medial plateau has a biplaner fracture in posterior coronal plane as well as sagittal plane. In such fractures it is imperative to fix the medial plateau with buttressing in both planes. One such fracture pattern of the proximal tibia managed by triple plating through dual posteromedial and anterolateral incisions is discussed in this case report with emphasis on mechanisms of this type of injury, surgical approach and management.
高能胫骨平台骨折给骨科医生带来了重大挑战和困难。胫骨平台骨折累及主要负重关节，可能改变膝关节运动学。胫骨近端关节面的解剖重建、肢体轴线（肢体对线）的恢复以及允许早期关节活动的稳定固定是治疗的目标。在复杂的双髁胫骨平台骨折病例中，单纯外侧钢板固定常伴有内翻畸形，而通过双切口双侧钢板固定可取得更好的效果。然而，有时会遇到一种复杂类型的双髁胫骨平台骨折，其中内侧平台在冠状面后方以及矢状面均为双平面骨折。在这类骨折中，必须在两个平面上用支撑钢板固定内侧平台。本病例报告讨论了一种通过双后内侧和前外侧切口采用三联钢板治疗的胫骨近端骨折模式，重点介绍了这类损伤的机制、手术入路和处理方法。
