Capella Marcello, D'Antonio Davide, Camazzola Daniele, Barberis Luca, Braconi Lorenzo, Risitano Salvatore, Massè Alessandro
School of Medicine, University of Turin, Turin, Italy.
Arthrosc Tech. 2025 Apr 28;14(7):103549. doi: 10.1016/j.eats.2025.103549. eCollection 2025 Jul.
Tibial plateau fracture patterns characterized by posteromedial (PM) column split, anterior cruciate ligament (ACL) bony avulsion, and posterolateral (PL) depression can constitute a tibial plateau fracture-dislocation with loss of correct femoral-tibial congruence. Managing these fracture-dislocations requires the reduction and fixation of the PL depression, the PM fragment, and ACL bony avulsion. PL depression with lateral meniscus entrapment often compromises the reduction of the PM column, which results in residual subluxation of the tibial plateau. This Technical Note describes a 3-step arthroscopy-assisted reduction and fixation of tibial plateau fracture-dislocations characterized by PM split, PL depression, and ACL avulsion. In the first step, PL depression arthroscopy-assisted reduction and temporary fixation is performed, and then an open posteromedial approach is used to reduce and fix the PM column split; finally, the PL tibial plateau is fixed with cannulated screws, and an arthroscopic ACL suture fixation is performed. The advantage of this technique is that the first arthroscopic step reduces the PL depression and manages the lateral meniscus, permitting proper PM column fixation in the second step, and the third step stabilizes the PL depression and repairs the ACL avulsion, ensuring anatomic reduction and fixation of the fracture and joint congruence.
以胫骨平台后内侧（PM）柱劈裂、前交叉韧带（ACL）撕脱性骨折和后外侧（PL）凹陷为特征的胫骨平台骨折模式可构成胫骨平台骨折脱位，导致股骨与胫骨正常对应关系丧失。处理这些骨折脱位需要对PL凹陷、PM骨折块和ACL撕脱性骨折进行复位和固定。伴有外侧半月板嵌顿的PL凹陷常影响PM柱的复位，导致胫骨平台残留半脱位。本技术说明介绍了一种三步关节镜辅助下复位和固定以PM劈裂、PL凹陷和ACL撕脱为特征的胫骨平台骨折脱位的方法。第一步，进行关节镜辅助下PL凹陷复位和临时固定，然后采用后内侧开放入路复位和固定PM柱劈裂；最后，用空心螺钉固定PL胫骨平台，并进行关节镜下ACL缝合固定。该技术的优点是第一步关节镜操作可减轻PL凹陷并处理外侧半月板，使第二步能正确固定PM柱，第三步可稳定PL凹陷并修复ACL撕脱，确保骨折的解剖复位和固定以及关节对应关系。
