Video Gallery

Arthroscopic Assisted Tibial Plateau Fracture Open Reduction Internal Fixation

February 10, 2018

Contributors: Amos Dai, BS; Rivka Chinyere Ihejirika, MD; Laith M Jazrawi, MD, FAAOS; Michael A Zacchilli, MD; Dylan Lowe, MD; Dylan Lowe, MD

Purpose: Tibial plateau fractures are devastating injuries that lead to restricted joint motion, knee instability, pain, and early arthritis. These injuries account for 1% of all fractures and often are complicated by meniscal or ligamentous injury. The Schatzker classification of tibial plateau fractures is a guide for understanding the mechanism of injury, injury severity, and need for surgical fixation. Historically, severe tibial plateau fractures were managed via large exposures, periosteal stripping, and numerous plates. Recently, attempts have been made to avoid periosteal stripping and use minimally-invasive, percutaneous methods of fracture fixation. For split-depression fracture types, the use of arthroscopy to visualize the articular surface while the depressed bone is tamped up from a cortical window below the joint has increased to preserve soft tissue and the blood supply to the zone of injury. Methods: This video discusses the case presentation of a 27-year-old man who fell onto his flexed left knee from a height of 10 ft while snowboarding and sustained a type II tibial plateau fracture. The video reviews the classification and surgical indications for tibial plateau fractures and demonstrates a minimally-invasive method for the management of a Schatzker type II tibial plateau fracture. An arthroscopic approach is used to visualize the joint. Medial and lateral meniscal tears are observed and débrided. Lateral articular depression is visualized arthroscopically, and the chondral surface is restored through a cortical window with the use of a bone tamp. This area is backfilled with the use of resorbable calcium phosphate cement, and the fracture is stabilized with the use of two 6.5-mm screws. Results: The patient is kept non–weight bearing with active range of motion for 6 to 8 weeks postoperatively. At 8 weeks postoperatively, the patient had range of motion from 0° to 115° and minimal pain with ambulation. Postoperative radiographs revealed a healed fracture with a smooth chondral surface. Conclusions: Schatzker type II tibial plateau fractures can be managed successfully via a minimally-invasive approach. Arthroscopic visualization affords a direct view of the chondral surface and is favored over intraoperative radiographs for establishing adequate restoration of the articular surface.