Tibial Plateau

Question 1

What is the surgical approach for posteromedial plating of the tibial plateau?

Answer 1

1) Incision 2cm posterior to posteromedial tibia
2) Find saphenous nerve, vein and pes tendons
3) incise fascia over medial gastroc and retract pes anteriorly
4) The plate is positioned on the posteromedial tibial surface, deep to the soleus and the pes tendons, and posterior to the insertion of the medial collateral ligament

Question 2

What is the surgical approach for anterolateral plating of the tibial plateau?

Answer 2

1) Incision is 1-2cm lateral to tibial spine, extend proximally over Gerdy’s tubercle and LFC
2) Incise fascia over tib ant 1cm off of bone to leave a cuff
3) Incise IT band in line with its fibers, starting at LFC
4) Release IT band ant/post from Gerdy’s tubercle
5) Perform capsulotomy if needed with enough cough for repair

Question 3

What specialty items may be needed for ORIF of tibial plateau fractures?

Answer 3

Femoral distractor, Langenbeck and/or Smilie retractors.
Weber clamps
Large periarticular quadrangular bone clamps
Number 2 Ethibond suture for retraction of meniscus after submeniscal arthrotomy
Bone tamps, curved and straight
Lambotte osteotomes for metaphyseal cortical window; Alternatively, 2.5- to 4.5-mm drill bits
Anatomically contoured lateral proximal tibial periarticular plates, standard buttress plate(s) and/or locking plate(s).
Long 3.5-mm cortical screws with 2.7-mm low-profile heads
Periarticular plate, one-third tubular, or 3.5-mm compression plate for medial or posteromedial buttress (Schatzker Type IV)
Distal radius 3.5-mm T-plate (old style); also useful for posteromedial side
Mini-fragment screws and mini-fragment plates (2.0/2.4 mm) depending on fracture comminution and fracture repair requirements
Cancellous allograft, osteobiologic bone void filler (e.g., CaPO4), cancellous allograft, or other product for subchondral support