Open reduction and internal fixation of tibial plateau fractures

A fracture of the tibial plateau often has a large fracture block that is separated from the tibial plateau and has varying degrees of displacement. If improperly treated, it often causes knee instability and knee valgus. In general, most of the tibial plateau fractures can be reset by manual reduction or squatting, and then fixed with tubular plaster. If the reset fails, a cut-off reset is required. Treatment of diseases: humeral stress fractures and tibial plateau fractures Indication A fracture of the tibial plateau often has a large fracture block that is separated from the tibial plateau and has varying degrees of displacement. If improperly treated, it often causes knee instability and knee valgus. In general, most of the tibial plateau fractures can be reset by manual reduction or squatting, and then fixed with tubular plaster. If the reset fails, a cut-off reset is required. Contraindications 1. The general situation of the wounded is not good, or the concomitant shock, must first rescue, until the shock is stable, the general situation can be improved before surgery. 2. If there is a life-threatening head, chest or abdominal cavity and other important organ damage, it must be treated first. The treatment of the fracture should be relegated to the secondary position. Temporary external fixation can be performed first, and the fracture should be treated after the condition is stable, or non-surgical treatment can be used. Try to get a better reset as much as possible. 3. There are more than 8 to 12 hours of open wounds in the fracture. Preoperative preparation 1. It is very important to routinely perform limb traction before surgery to return the femoral head from the posterior superior aspect of the acetabulum to the acetabular level. Traction can relax the contracted muscles, on the one hand, it can make the operation reset easily and prevent postoperative dislocation; on the other hand, it can reduce the cartilage surface necrosis and avascular necrosis of the femoral head after compression of the femoral head. opportunity. Older, dislocated children can be used for traction; older age should be treated with humeral traction. Generally, the femoral head can be lowered to the acetabular plane after 2 to 3 weeks of traction. After the X-ray film is confirmed, the weight can be appropriately reduced, and the femoral head can be maintained in the plane for 1 to 2 weeks. 2. If the traction of the femoral head is not obvious, it should be checked whether it is caused by the contraction of the femoral or gluteal muscles. In this case, the adductor muscle starting point should be cut or released, and then the limbs should be pulled to meet the traction requirements. Generally speaking, those who are more than 2 to 3 years old need to be cut off and can be released. 3. Preoperative cases were prepared for skin around the hip joint and lower limbs for 3 days. 4. Preoperatively, the anteversion angle, the hip valgus angle, the selected capping site, the hip osteotomy site, and then the surgical design of the femoral or hip bone osteotomy angle and the size of the bone graft should be determined. 5. Prepare blood 200 ~ 600ml. 6. The fracture of the tibial plateau often involves the rupture of the collateral ligament, cruciate ligament and meniscus of the knee joint. It is necessary to perform the necessary examination before surgery and prepare the applied instruments. 7. The fractures found during surgery are often heavier than those shown on the preoperative x-ray, and there must be sufficient estimates. 8. The fracture has a change in the articular surface compression depression. After lifting the joint surface, there are many bone defects, and bone grafting should be prepared. Surgical procedure Take the lateral plateau fracture of the tibia as an example. 1. Position: supine position. 2. Incision: The anterior lateral incision of the knee joint (the anterior medial incision of the knee joint is used for the medial platform fracture), and the lower end is appropriately extended. 3. Expose the lateral platform: the incision of the anterior tibialis anterior muscle [Fig. 1 (1)], the outer end of the incision should not be too long, so as not to damage the common peroneal nerve. Do not separate the anterior tibial muscle from the fracture block to ensure the blood supply of the fracture block. Pulling the anterior tibialis anterior muscle flap outwards reveals the anterior aspect of the lateral platform fracture. 4. Exploring and cleaning the joint cavity: the switch sac is cut along the outer edge of the humerus to remove the hematoma and bone fragments. If there is a broken meniscus, it should be removed and the joint surface should be carefully examined. If the meniscus is not ruptured, the soft tissue on the anterior and surrounding sides can be opened and the fracture of the tibial articular surface can be opened. The fracture can be a single piece, but most of them are comminuted fractures, and all fractures with cartilage surfaces should be preserved. 5. Reconstruction of the articular surface: First, the assistant pulls down and adducts the calf, opens the lateral joint space, and pulls a large lateral fracture block together with the muscle attached to it to expose the deep fracture. The surgeon uses the periosteal stripper to carefully lift the collapsed articular surface to reset the joint. The large fracture block pulled outward is then reset. Then, the drill is drilled from the lateral malleolus fracture block to the inside and drilled through the humerus. Pass the bolt through the tunnel and make a small incision on the skin at the inner ankle to reveal the bolt and fix it with a nut. After the reduction of the tibial articular surface fracture block, a small amount of bone damage in the lower part of the bone can be taken from the cortical bone of the tibia and the cancellous bone of the femoral condyle; the large bone defect should be transplanted with the tibial bone to avoid the postoperative articular surface recanalization. Collapse. After internal fixation and bone grafting, rinse and absorb the blood in the joint cavity to remove the broken bone pieces. If the meniscus has not been removed and the circumference has been cut, it should be carefully sutured. The anterior tibialis anterior muscle, subcutaneous tissue and skin are then sutured by layer. complication fracture.

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