Innovative Use of Posterior Vertebral Wall Impactor in Tibial Plateau Depressed Fractures
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SURGICAL TECHNIQUE
Innovative Use of Posterior Vertebral Wall Impactor in Tibial Plateau Depressed Fractures Atul Sareen1 · Hitesh Lal1 · Shaffaf Abdul Kareem1,2 Received: 24 June 2020 / Accepted: 7 September 2020 © Indian Orthopaedics Association 2020
Abstract Depressed articular fractures of tibial plateau are treated by elevation of the fracture fragments to maintain the articular congruity and filling the void with any bone substitutes, followed by screw or plate fixation. This elevation of the fragments to maintain articular congruity poses a surgical challenge even in experienced hands. Many techniques have been described for the same, as the use of the metallic-bone-tamps, elevators and more recently inflatable-balloon-tamps. But due to the lesser cross-section area, these often led to comminution of the fragile articular bone fragments. The inflatable-balloon-tamp caused extrusion of contrast-dye or unintentional posterior-wall displacement. We treated a series of 25 patients with tibial plateau depressed fractures by a novel technique using posterior-vertebral-body-wall-impactor. This helped in a uniform dissipation of force over a large cross-sectional area under the fracture fragment, leading to minimal comminution of the depressed fragment, maintaining the articular congruency. Rest of the fixation was done in the standard manner. There were no intra-operative or post-operative complications. All patients had good knee function according to Rasmussen Knee Function Grading System and achieved radiological union of fracture at follow-up (with a range of 12–18 months). Hence, this technique may be a safer and effective alternative for the elevation of depressed articular fractures of tibia. Keywords Tibial plateau fracture · Depression · Posterior vertebral body wall impactor · Pedicle subtraction osteotomy
Introduction In the 2018 Orthopaedic Trauma Association (OTA) fracture and dislocation classification compendium, tibial plateau depression fractures are included in 41B2, and split-depression fractures in 41B3 [1]. While in Schatzker classification of tibial plateau fractures, types II, III, and V involves depression of articular surface of tibia [2]. In these fractures, anatomic reduction with restoration of the articular surface is necessary; or else it may lead to persistent incongruity due to the knee flexion instability or posttraumatic arthritis * Shaffaf Abdul Kareem [email protected]; [email protected] Atul Sareen [email protected]
[3]. Traditionally, bone tamps (curved or straight) were used to elevate the depressed articular fragment (Fig. 1), which often led to splitting and comminution of the depressed articular bone chunk even in non-osteopenic bone [4, 5]. This manuscript reviews the innovative technique used by the authors, wherein a posterior vertebral body impactor is used to elevate the articular depression (Fig. 2).
Methods Twenty-five cases of tibial plateau fractures with significant articular depression were treated by the authors using the technique described bel
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