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???
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Vijayanand Addanki Lateral locking plate with or without medial buttress plate..depending on intra op stability. ..maintenance of intra articular congruity is a must -
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Suhas Singh Thaactually sir, your post op x ray is worse ….you have attempted CRIF.i suppose…! Was a traction table used ???
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DrAvinash Mahender Your lat condyle looks intact btw… So posteromedial buttress plating will be enough…. Do a ct and plan
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Shahab Ud Din I appreciate ur work but ct scan in preop: planning is essiental for management. Ideal fixation bilateral locking plates / illiozarove -
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Manpal Narula We 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 -
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Ajit Saigal Have to revise. Reduction / bone grafts & Anterolateral plate. Check fixation .If needed medial plate fixation -
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Mohit Kumar The post op is worse than preop….remember the first commandment of any surgery «thou shall do no harm» -
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Jai Vardhan Singh Bicondylar 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. -
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Sudhir Pai All principles of periarticular fixation violated. Biplate (lateral + PM plates+elevation+ Bg -
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Pratyush Gupta revise for sure. either ask before fixation if you dont know the management or dont show cases which will depress your teachers. -
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Pratyush Gupta i am sorry for hard words but please spread the words to surgeon if you can. we would love to guide
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Narayana Prasad It’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. -
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Paul Antony First we should a CT
Then make a plan
so many sites are there how yo manage these types of fractures
At least go through AO site surgery reference. It is free. They have covered it nicely -
Ahmad Bo-Eisa It is very bravery of you Mayur Jejurikar to post such a case. Thank you. We all do mistakes.
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 Abdelhaleem there 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 Mahadik Ariticular 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??? -
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Anil Mittal Ct 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 -
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Narayana Prasad The 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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Narayana Prasad Tender care means not to compromise on biology, by preserving we should go ahead. To plan on the incision a CT is mandatory, 3d is more a luxory
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