OPTIMAL SURGICAL MANAGEMENT OF HIGH VELOCITY POSTERIOR TIBIAL PLATEAU FRACTURE SUBLUXATIONS (DUPARC, REVISED CLASSIFICATION, GROUP ?? V: POSTERO-MEDIAL FRACTURE) BY DIRECT, DORSAL APPROACH ?? A CHANGING TREND: A PROSPECTIVE STUDY

Abstract

B. Pardhasaradhi1, M. Pandu Ranga Vital2, N. Purushothama Rao3, Y. Nageswara Rao4

High-energy tibial plateau fractures are infrequent and technically demanding to treat especially if those are shearing type, coronal plane, displaced fractures. The most widely used the Schatzker system of classification,[1] (Based on the AP radiograph) is more than likely to miss postero-medial and postero-lateral shear fractures, best visible on the lateral, than the AP radiograph. These fractures have recently been characterised by two studies, highlighting their clinical relevance [2,3] and showing that less invasive surgery and indirect reduction techniques are often inadequate. Hohl described unicondylar coronal plane splitting fractures of the medial tibial plateau, noted that these injuries be considered as fracture-dislocations. Connolly and others have suggested that the mechanism involved in this fracture pattern is one of knee flexion, varus, and internal rotation of the medial femoral condyle.[4,5,6] Consistent among these and other authors is that the occurrence of this fragment is relatively unusual and that the use of a posteriorly based exposure with direct fracture visualization, anatomic reduction and absolute stability appears to result in satisfactory outcomes. Though variations of a postero-medial approach been previously described (by Trickey et al and also by Burks et al.,), more recently, Lobenhoffer et al described direct posterior exposure, Wang et al described postero-medial approach and Luo et al. described the approach for the management of posterior bicondylar tibial plateau fractures.[7,8

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