Tibial Plateau Fracture External Fixation

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Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Template fracture reductions

  • draw key fragments of fracture and plan for reduction

2

Execute surgical walkthrough

  • resident can describe key steps of the operation verbally to attending prior to beginning of case
  • describe potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • External Fixation System

2

Room setup and equipment

  • radiolucent flat top table
  • c-arm fluoroscopy

3

Patient positioning

  • place patient supine
  • place a sterile bump or triangle under the knee
G

Proximal Pin Placement

1

Mark out the placement of the Schanz pins

2

Make a stab incision at the site of the pin placement

3

Bluntly dissect down to the bone

4

Place the proximal pins

  • place 2 Schanz pins alont the anterolateral thigh
  • place these pins in the midshaft of the femur
H

Distal Pin Placement

1

Mark the site of the tibial pin insertion

2

Make a stab incision at the site of pin placment

3

Bluntly dissect down to bone

4

Place the distal pins

  • place 2 Schanz pins into the midshaft and distal tibia
  • place the pins far enough away from the distal extension of the proximal tibia that there will be no interference in the event future incisions are needed for definitive fixation
I

Bar Placement

1

Loosley place a bar to connect the proximal and distal pins

  • place a solitary bar to span all of the pins
J

Reduction

1

Reduce the fracture

  • perform longitudinal traction to reduce the fracture

2

Confirm placement

  • confirm under fluoroscopy

3

Position the knee

  • maintain slight flexion of the knee
  • check reduction with fluoroscopy
K

Final Tightening

1

Tighten the external fixator

  • tighten all of the connectors
  • this is done to maintain ligamentotaxis reduction
L

Multibar Fixation (optional)

1

Irrigation, hemostasis, and drain

  • connect the two proximal pins using a single bar
  • connect the two distal pins using another bar
  • these bars are then used to manipulate the fracture to achieve reduction of the plateau

2

place a third bar to connect the proximal and distal bars

  • tighten the bars to maintain reduction
Postoperative Patient Care
 

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