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Posteromedial Approach to Tibial Plateau Fracture Nonunion

March 01, 2020

Contributors: Nima Eftekhary, MD; Charlotte N Shields; Kenneth A Egol, MD, FAAOS

Keywords: Nonunion

Purpose This video demonstrates a posteromedial approach for management of a Moore type I tibial plateau fracture nonunion. Methods The patient is a 62-year-old man who was struck by an sport utility vehicle 7 months ago and was diagnosed with a posteromedial tibial plateau fracture, which was initially managed nonsurgically. An atrophic intra-articular nonunion developed. The patient underwent repair of the plateau nonunion with the use of an iliac crest bone graft and a posterior plate via a posteromedial approach. Results The nonunion was repaired via a prone posteromedial approach to the tibia with the use of a posterior plate and an iliac crest bone graft. Anatomic reduction and stable fixation were obtained via this technique. The patient did very well postoperatively and had range of motion from 0° to 100° at a follow-up of 6 weeks. Conclusion The principles of fragment stabilization and biologic enhancement at the nonunion site were applied successfully in this patient. A posteromedial approach was necessary for the management of this nonunion of the posteromedial aspect of the knee joint.

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