Tibia plateau fractures getting worse all the time
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1 Session 4: the knee: part I Tibia plateau fractures getting worse all the time Christoph Sommer, Head of Trauma Surgery
2 Session 4: the knee: part I Tibia plateau fractures getting worse all the time Christoph Sommer, Head of Trauma Surgery
3
4 AO B3- and C2/3-type (Schatzker II, IV-VI) KSGR 1-2/2017
5 AO B3- and C2/3-type (Schatzker II, IV-VI) KSGR 1-2/2017
6
7 Prox Tibia Fx Wintersport (Ski, SB) (KSGR ) All (all Fx Fixations) 146 (2951) N % 4.9% 180 (3874) N % 4.6% 185 (4813) N % 3.8% B1 / B % % % B % % % C1 / C % % % C % % % Fx Dislocation (Moore types) 2-staged procedure % % % % % %
8 1. Change: carving technique
9 2. Change: artificial snow
10 AO B3- and C2/3-type (Schatzker III-VI) new admissions 1-2/2011 KSGR Chur
11
12 Postop: Free functional Postop: No active extension against gravity/resistance ligaments intact simple Fx partial articular Fx split depression Fx (AO B3.1) (Schatzker II) ACL (eminentia) osseous avulsed Fx dislocation partial articular Fx Moore II medial (AO B3.2/B3.3) (Schatzker IV) tuberosity injured lig pat avulsed Complex Fx complet articular Fx AO C3.3 (Schatzker VI)
13 Postop: Free functional ligaments intact simple Fx partial articular Fx split depression Fx (AO B3.1) (Schatzker III)
14 simple Fx partial articular Fx split depression Fx (AO B3.1) (Schatzker III) P.M., LCP: Case 41y, collection: ski accident, Tibia proximal B3 PL
15 P.M., LCP: Case 41y, collection: ski accident, Tibia proximal B3 PL
16 P.M., LCP: Case 41y, collection: ski accident, Tibia proximal B3 PL PCL ACL
17 P.M., LCP: Case 41y, collection: ski accident, Tibia proximal B3 PL
18 P.M., LCP: Case 41y, collection: ski accident, Tibia proximal B3 PL Op, day 3, in lateral decubitus position
19 P.M., LCP: Case 41y, collection: ski accident, Tibia proximal B3 PL Op, day 3, in lateral decubitus position
20 P.M., LCP: Case 41y, collection: ski accident, Tibia proximal B3 PL Op, day 3, in lateral decubitus position
21 P.M., LCP: Case 41y, collection: ski accident, Tibia proximal B3 PL 14 months
22 P.M., LCP: Case 41y, collection: ski accident, Tibia proximal B3 PL 14 months
23 P.M., LCP: Case 41y, collection: ski accident, Tibia proximal B3 PL 14 months
24 Postop: Free functional ligaments intact simple Fx partial articular Fx split depression Fx (AO B3.1) (Schatzker III)
25 Postop: Free functional ligaments intact simple Fx partial articular Fx split depression Fx (AO B3.1) (Schatzker III) ACL (eminentia) osseous avulsed Fx dislocation partial articular Fx Moore II medial (AO B3.2/B3.3) (Schatzker IV) tuberosity injured lig pat avulsed Complex Fx complet articular Fx AO C3.3 (Schatzker VI)
26 Treatment goals 1. Respect soft tissue (approach(es), timing) 2. Anatomic restoration articular surface(s) 3. Stable fixation fx fragments (including tibial spine(s) in correct alignment (axis, length, rotation) 4. Repair of menisical and/or ligamentous injuries as far as necessary and possible
27 Treatment goals 2-3 staged procedure, initial ex fix knee bridging 1. Respect soft tissue (approach(es), timing) 2. Anatomic restoration articular surface(s) 3. Stable fixation fx fragments (including tibial spine(s) in correct alignment (axis, length, rotation) 4. Repair of menisical and/or ligamentous injuries as far as necessary and possible
28 F.M., 48y, ski, 41-C3, compartment syndrom 3h after injury DCO Damage Control Orthopedics
29 F.M., 48y, ski, 41-C3, compartment syndrom
30 F.M., 48y, ski, 41-C3, compartment syndrom
31 Temporary ex fix proximal tibia (KSGR )* 262 (851 prox tibia fx) Soft tissue injury Compartment syndrom 76 Open fracture 49 Fracture classification (AO) * B3 69 (Moore II) C1 9 C2 21 C3 144 (total: 171) Acklin, Sommer. Compartment syndrome in dislocation and non-dislocation type proximal tibia fractures: analysis of 356 consecutive cases. Arch Orthop Trauma Surg (2012) 132:
32 Postop: Free functional ligaments intact simple Fx partial articular Fx split depression Fx (AO B3.1) (Schatzker III) tuberosity injured lig pat avulsed Complex Fx complet articular Fx AO C3.3 (Schatzker VI)
33 J.U., 31y, AO C3, Moore V, 2-step-proc. C3-type Ex Fix, then CT Scan
34 J.U., 31y, AO C3, Moore V, 2-step-proc. Postop 1 medial
35 J.U., 31y, AO C3, Moore V, 3-step-proc. Op 2, medial, day 8 medial extensive approach (1.step)
36 J.U., 31y, AO C3, Moore V, 3-step-proc. Op 2, medial, day 8 skin
37 J.U., 31y, AO C3, Moore V, 3-step-proc. Op 2, medial, day 8 skin
38 J.U., 31y, AO C3, Moore V, 3-step-proc. Op 3, central, lateral, day 16
39 J.U., 31y, AO C3, Moore V, 3-step-proc. Op 3, central, lateral, day 16
40 J.U., 31y, AO C3, Moore V, 3-step-proc. Op 3, central, lateral, day 16
41 J.U., 31y, AO C3, Moore V, 3-step-proc. Op 3, central, lateral, day 16
42 J.U., 31y, AO C3, Moore V, 2-step-proc. 14 months
43 Postop: Free functional ligaments intact simple Fx partial articular Fx split depression Fx (AO B3.1) (Schatzker III) tuberosity injured lig pat avulsed Complex Fx complet articular Fx AO C3.3 (Schatzker VI)
44 Postop: Free functional ligaments intact simple Fx partial articular Fx split depression Fx (AO B3.1) (Schatzker III) ACL (eminentia) osseous avulsed Fx dislocation partial articular Fx Moore II medial (AO B3.2/B3.3) (Schatzker IV) tuberosity injured lig pat avulsed Complex Fx complet articular Fx AO C3.3 (Schatzker VI)
45 Moore II F.S., male, 42y, ski accident
46 F.S., male, 42y, ski accident 3 operative goals reduction of postlat depression posteromedial buttressing fixation of tibial spine (ACL) one (larger) anteromedial approach* * Potocnik, Acklin, Sommer. Operative strategy in postero-medial fracture-dislocation of the proximal tibia. Injury, Int. J. Care Injured 42 (2011)
47 Moore II L.M., female, 66y, ski accident 2 years
48 Moore II L.M., female, 66y, ski accident 2 years
49 L.M., LCP: female, Case collection: 66y, Tibia ski proximal accident Op 1, after Fix ex
50 L.M., LCP: female, Case collection: 66y, Tibia ski proximal accident Op 1, after Fix ex
51 L.M., female, 66y, ski accident Op2, day 8
52 L.M., female, 66y, ski accident Op2, day 8
53 L.M., female, 66y, ski accident Op2, day 8
54 L.M., female, 66y, ski accident Op2, day 8
55 L.M., female, 66y, ski accident Op2, day 8
56 L.M., female, 66y, ski accident Op2, day 8 postlateral impression
57 L.M., female, 66y, ski accident Op2, day 8 Reversed LCP medial distal tibia plate 3.5 (low bend)
58 L.M., female, 66y, ski accident Op2, day 8 Reversed LCP medial distal tibia plate 3.5 (low bend)
59 L.M., female, 66y, ski accident Postop 2
60 L.M., female, 66y, ski accident 17 months
61 Tibia plateau fractures- getting always worse!? take home message Worse with craving/artificial snow 3 typical fracture pattern «simple» fx: 1-staged procedure «complex» fx / fx dislocation: 2-staged Mostly: open surgery with plates/screws 3 operative goals reduction of postlat depression posteromedial buttressing fixation of tibial spine (ACL) 3h after injury DCO Damage Control Orthopedics Postop: Free functional Postop: No active extension against gravity/resistance ligaments intact simple Fx partial articular Fx split depression Fx (AO B3.1) (Schatzker II) ACL (eminentia) osseous avulsed Fx dislocation partial articular Fx Moore II medial (AO B3.2/B3.3) (Schatzker IV) tuberosity injured lig pat avulsed Complex Fx complet articular Fx AO C3.3 (Schatzker VI)
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