Percutaneous treatment of tibial plateau fractures

Abstract

In France, 11,294 proximal tibia fractures occurred in 2018 and 6880 surgical procedures were done to treat them. Most of these were tibial plateau fractures, although fractures can occur in the metaphysis only or in the intercondylar eminence. The proximal tibia's poor vascularization justifies sparing it by doing a percutaneous treatment, setting the stage for bone union. The treatment must be based on rigorous planning with 3D imaging to determine the type of fracture accurately. The goals of treatment are first to realign the lower limb and then to reduce the articular surface, while addressing any associated injuries. Percutaneous reduction is based on ligamentotaxis and the use of spatulas or balloons that spare the vascularization. Surgical navigation and arthroscopy are precious tools for verifying the reduction. There are several options for stabilization, ranging from using polymethylmethacrylate cement for a Schatzker III fracture to applying a cannulated screw or doing MIPPO (Minimal Invasive Percutaneous Plate Osteosynthesis) with an anatomical plate and adjustable locking screws placed under the depression in complex fractures. Percutaneous surgery is not about the size of the incisions; the focus is on sparing the metaphysis and its vascularization to ensure high-quality and long-lasting stability. It appears to yield better functional outcomes than open reduction and internal fixation, not only for Schatzker type I, II and III fractures, but also for complex fractures where open fixation is more damaging and the source of complications.

Keywords: Bone cement; Fracture fixation; Fracture plates; Percutaneous surgery; Tibial fractures.