Hare Kristoffer B, Brand Eske, Bloch Thomas
Department of Orthopedics, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.
Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.
Trauma Case Rep. 2020 Jun 28;29:100331. doi: 10.1016/j.tcr.2020.100331. eCollection 2020 Oct.
Proximal tibial fractures are common with an incidence of 10.2/100.000. Those displaced and involving the articular surface will often require surgical treatment. However, no consensus exists on whether to allow the patient early weight bearing or not. We developed a technique using structural bone chips, highly impacted under the articular surface, to permit immediate weight bearing after surgery.
The patient was a 44-year old male who suffered a lateral tibial plateau fracture (AO type 41B2).
We used an anterolateral approach with an S-shaped incision. A small window in the tibia was made using an awl, and the articular surface was reduced under radiographic imaging. The bone allograft was prepared by splitting the frozen femoral head in quarters and then taking large pieces of bone with a bone rongeur forceps avoiding the cartilage. The large pieces of bone were gathered in a small tray and thereafter compressed into the drill guide insert. The drill guide filled with bone graft was then inserted into the tibia window and directed in the appropriate position guided by radiography. Hereafter, the bone graft was impacted under the articular surface with force using the appropriate trocar and a hammer, and the fracture was finally reduced. Finally, the fracture was fixated utilizing an angular stable plate.
The patient was followed up one year postoperatively and allowed immediate weight bearing after surgery. No subsequent articular collapse occurred.
In this case, we present a proximal tibial fracture with articular depression, which was surgically treated with a highly impacted bone allograft of large pieces and a locking plate. The patient was allowed immediate weight bearing and no subsequent articular collapse occurred.
胫骨近端骨折很常见，发病率为10.2/100,000。那些移位且累及关节面的骨折通常需要手术治疗。然而，对于是否允许患者早期负重尚无共识。我们开发了一种技术，使用结构性骨块，在关节面下高度嵌压，以允许术后立即负重。
患者为一名44岁男性，患有外侧胫骨平台骨折（AO 41B2型）。
我们采用前外侧入路，做S形切口。用锥子在胫骨上开一个小窗口，在影像学引导下复位关节面。骨移植材料通过将冷冻的股骨头切成四等份制备，然后用咬骨钳取大块骨，避开软骨。将大块骨收集在一个小托盘里，然后压入钻套插入物中。然后将装满骨移植材料的钻套插入胫骨窗口，并在影像学引导下置于合适位置。此后，使用合适的套管针和锤子用力将骨移植材料在关节面下嵌压，最终复位骨折。最后，使用角稳定钢板固定骨折。
患者术后随访一年，术后允许立即负重。随后未发生关节塌陷。
在本病例中，我们展示了一例伴有关节凹陷的胫骨近端骨折，采用大块高度嵌压的骨移植材料和锁定钢板进行手术治疗。患者术后允许立即负重，随后未发生关节塌陷。
