OPEN REDUCTION AND INTERNAL FIXATION (ORIF) OF A LATERAL TIBIAL PLATEAU FRACTURE

Indications

• Clinical: instability of the knee on valgus testing.

• Radiological: split, central depression or split depression fracture types.

• Joint depression > 3 mm.

Pre-operative planning

Clinical assessment

• Swollen knee.

• Valgus deformity common.

• Common peroneal palsy possible but rare.

• Compartment syndrome – possible but rare.

Radiological assessment

• An anteroposterior (AP) radiograph is most useful to detect fractures and assess degree of joint depression (Fig. 12.1).

• A lateral radiograph is less helpful in determining the degree of depression.

• A CT scan is most useful for additional imaging-mainly indicated in cases where there is doubt about the extent or degree of depressionandincomplexfractures (Fig. 12.2a,b).

Operative treatment

Anaesthesia

• General anaesthesia preferred – avoid local blocks/spinal anaesthesia which mask symptoms and signs of compartment syndrome.

• Prophylactic antibiotics at induction.

Equipment

• Standard AO set with reduction clamps and Kirschner wires.

• Radiolucent table with ability to flex at the level of the knee.

• Equipment to harvest bone graft or calcium phosphate cement.

Set up

• Instrumentation on the side of the injured leg.

• Image intensifier on contralateral side.

• Knee flexed at 90° at the outset of the procedure to facilitate exposure (Figure 12.3a,b).

• Knee brought into extension once the fracture is reduced to complete fixation.