Open Reduction and Internal Fixation Compared with Circular Fixator Application for Bicondylar Tibial Plateau

Fractures

by Jeremy A. Hall, Murray J. Beuerlein, and Michael D. McKee

J Bone Joint Surg AmVolume 91(Supplement 2 Part 1):74-88

March 1, 2009

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

A preoperative computed tomography scan clarifies the main fracture lines.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Patient positioning.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Traction can be applied with use of either manual means, a femoral distractor, or, rarely, a fracture table.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Following reduction of the articular surface, a fracture clamp is applied percutaneously.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Initial application of the frame.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Wire insertion.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Fixation of the wires to the frame.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Distal fixation of the fixator.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Preoperative radiograph of a displaced bicondylar tibial plateau fracture in a thirty-two-year-old man.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Two operative approaches can be used: (1) a single anterior incision (left), which usually involves substantial soft-tissue stripping, or (2) the preferred two-incision approach (right).

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.

Jeremy A. Hall et al. J Bone Joint Surg Am 2009;91:74-88

©2009 by The Journal of Bone and Joint Surgery, Inc.