M.E.Müller: Atlas: Fracture 41-C2

Tibia/Fibula, Proximal, complete
articular fracture, articular simple,
metaphyseal multifragmentary
0,33% of the total
1,72% of the tibia
6,90% of the segment

80 fractures
44,2% group
54%M, 46%F

48 fractures
26,5% group
63%M, 37%F

53 fractures
29,3% group
74%M, 26%F

Intact wedge +Q Fragmented wedge +Q Complex

These are complete articular fractures of the proximal tibia involving the articular surface with a simple fracture line and the metaphyseal area with a multifragmentary, wedge-shaped fracture line. Ref. Manual of Internal Fixation:
208 - 213. 568 - 577.
Surgeon. RO.

The 3D CT scanning images, a requirement in the near future, are very useful for the preoperative planning of the difficult type C fractures.

We want to emphasize the importance of the anatomic

reduction of the articular surface, the essential bone grafting (the freeze-dried bone graft is very efficacious and avoids the need for a second operation) and the advisability of placing a contra-lateral plate, even if it is ad minimum, in order to neutralize the flexion stresses.

preoperative preoperative

preoperative

preoperative preoperative

+ 4 months + 4 months

These are complete articular fractures of the proximal tibia involving the articular surface with a simple fracture line and the metaphyseal area with a multifragmentary, wedge shaped fracture line. Ref. Manual of Internal Fixation:
208 - 213. 568 - 577.
Surgeon. CS.

This case is shown to illustrate a detail of the surgical technique that can be very useful in the treatment of these difficult fractures. An osteotomy of the tibial tuberosity can be useful in order to visualize the complex articular fracture, reduce it, bone graft it and puzzle out the epiphyseal-metaphyseal fragments; the osteotomy is internally fixed thereafter by an antero-posterior lag screw. In cases where there is a frontal plane fragment

that includes the tibial tuberosity, it should undoubtely be carefully opened in order to use the advantages of the intraosseous approach that the fracture itself offers.

In the illustrated case, the relative preservation of the medial cortex and the efficacy of the lag screws make the semi-tubular plate sufficient for neutralization, without a contralateral plate; this is an exception.

preoperative preoperative

postoperative postoperative

+ 1 year + 1 year




						Tibia/Fibula, Proximal, complete articular fracture, articular simple, metaphyseal multifragmentary	0,33% of the total 1,72% of the tibia 6,90% of the segment






These are complete articular fractures of the proximal tibia involving the articular surface with a simple fracture line and the metaphyseal area with a multifragmentary, wedge-shaped fracture line.		Ref. Manual of Internal Fixation: 208 - 213. 568 - 577. Surgeon. RO.

The 3D CT scanning images, a requirement in the near future, are very useful for the preoperative planning of the difficult type C fractures. We want to emphasize the importance of the anatomic	reduction of the articular surface, the essential bone grafting (the freeze-dried bone graft is very efficacious and avoids the need for a second operation) and the advisability of placing a contra-lateral plate, even if it is ad minimum, in order to neutralize the flexion stresses.






These are complete articular fractures of the proximal tibia involving the articular surface with a simple fracture line and the metaphyseal area with a multifragmentary, wedge shaped fracture line.		Ref. Manual of Internal Fixation: 208 - 213. 568 - 577. Surgeon. CS.

This case is shown to illustrate a detail of the surgical technique that can be very useful in the treatment of these difficult fractures. An osteotomy of the tibial tuberosity can be useful in order to visualize the complex articular fracture, reduce it, bone graft it and puzzle out the epiphyseal-metaphyseal fragments; the osteotomy is internally fixed thereafter by an antero-posterior lag screw. In cases where there is a frontal plane fragment	that includes the tibial tuberosity, it should undoubtely be carefully opened in order to use the advantages of the intraosseous approach that the fracture itself offers. In the illustrated case, the relative preservation of the medial cortex and the efficacy of the lag screws make the semi-tubular plate sufficient for neutralization, without a contralateral plate; this is an exception.