[Arthroscopic treatment of tibial plateau fractures].

OBJECTIVE

The aim of arthroscopically assisted treatment of tibial plateau fractures is to achieve minimally invasive reduction and internal fixation of the joint fracture of the tibial plateau. Using the arthroscopic procedure, both the approach morbidity and the control of the articular reduction can be optimized.

INDICATIONS

Displaced tibia plateau fractures of AO type A1 and B1/2/3 or Tscherne P2.

CONTRAINDICATIONS

Strongly displaced tibial plateau fractures, which require an open surgical approach and stabilization with plate fixation (e.g., AO type C fractures or Moore type 5 fractures); 2nd and 3rd degree open fractures. Danger of compartment syndrome.

SURGICAL TECHNIQUE

Planning of the surgical approach and confirmation of the indication by CT imaging. Diagnostic arthroscopy of the knee joint with treatment of associated injuries and confirming the indications for arthroscopically assisted reduction. Under arthroscopic control, insertion of an ACL tibial aiming device. In the central portion of the dislocated fracture fragment, a 2.4 mm K-wire is placed with the help of the aiming device. Opening of the outer cortex using a cannulated drill (9-11 mm diameter), introduction of a cannulated plunger below the fracture resulting in reduction of the fracture and compression of the cancellous bone below the fracture. Simultaneously the reduction is controlled by arthroscopy. Finally, the fracture is fixed using minimally invasive screw fixation (3.5-7.3 mm cancellous screws with washers) or by plate osteosynthesis (e.g., support plate). The metaphyseal defect can optionally be filled with bone substitute material.

POSTOPERATIVE MANAGEMENT

Rehabilitation is dependent on the extent of the fracture. In arthroscopically treated fractures, partial weight bearing of 20 kg over a period of 6-12 weeks is usually necessary.