45 yrs male, motorcycle accident, 12 days old tibial plateau fracture schatzker 5, ao 41c31, closed reduction, ligamentotaxis, fixed by cannulated hip screw. Expert comments plz n also future management???
Manpal NarulaWe all know what kind of fixation this is and the poor prognosis if we leave it like this . Needs lateral buttress plate with elevation and BG .posteromedial separate plate is must through a sep incision. Please try to get ct scan in these fractures
Jai Vardhan SinghBicondylar fracture,coronal split of medial condyle, with significant articular depression ( more on post-op)and communition. Posteriomedial Buttressing should be done with BG+ additional buttress plate/ screws from lateral side.
Narayana PrasadIt’s a classical example how a case may be buggered up. Is there any pre op CT available ? How can u manage a type 5 scht. With this kind of fixation? You should boldly go head and redo it without any hesitation. Patient may be unhappy for the time being when you ask for a redo, if you don’t do it he will be ur lifelong enemy.
Schatzker type 5 even though it looks more benign preop, Ideally, after soft tissue improve, open reduction is needed with reduction of depression and fix it with subcondral screws and a lateral hokey plate preferably LCP. Another postero medial small fragment semitubular plare may be needed. Avoid cast as possible and start early ROM. Another method is a ring fixation.
Mustafa Abdelhaleemthere is a central dep. in the art. surface of lat. condyle and not reduce , needs grafting and batrous plate + no compression was done , soon revision should be done by grafting and batrous plate in the lat. side with another 2 short serrated cancellous screws in the medial condyle
DrHrishikesh MahadikAriticular surface is not reduced. Patient will develop OA knee in future. Should have used stienmann pin as a joystick to reduce the fracture and bone clamp to hold it before putting the cannulated screws.. Did u use traction table???
Anil MittalCt is must 3d. Then treat on table heavy traction with calc. Pin and then pass a cannulated screw by closed means from lat. Side under c arm. Then fix med cond by ao 3.5 upper tibia postero medial plate
Narayana PrasadThe key in this type of fracture is the reconstruction of posterio medial corner o some time the posterior wall itself. Without a proper CT we cannot go further at all. I feel it’s criminal to do such fixation and invite litigation
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