PLATEAU胫平台外侧髁课件.ppt

* The AP and lateral radiographs demonstrate a lateral split depression tibial plateau fracture. The CT scan of the articular surface demonstrates impaction of the anterior portion of the plateau (arrows). AP radiograph Lateral radiograph The CT scan of the articular surface demonstrates impaction of the anterior portion of the plateau (arrows). CAT scan at the top of the fibular head region demonstrates a nondisplaced crack through the lateral fragment (dotted area). Multiple incisions and approaches are possible for tibial plateau fractures. The use of a direct anterior incision will enable further reconstructive surgery to be performed more easily if necessary at a later date. The incision is slightly lateral to the midline such that it comes down just lateral to the tibial tubercle and over the anterior compartment musculature rather than the tibial crest. A full thickness fascial cutaneous flap is raised above the iliotibial band towards the lateral side only. No medial dissection is necessary. ITB The iliotibial band is then split in line with its fibers but not through the knee capsule. ITB The retraction of the iliotibial band posteriorly exposes the bulging joint capsule. The retraction of the iliotibial band posteriorly exposes the bulging joint capsule. JOINT CAPSULE ITB The Freer elevator is demonstrating the level of the superior surface of the joint on the displaced lateral fragment. JOINT CAPSULE The coronary ligament is released, exposing the meniscus. Sutures are placed within the meniscus to allow for its superior retraction. CORONARY LIGAMENT LATERAL MENISCUS SUTURES The coronary ligament is released, exposing the meniscus. Sutures are placed within the meniscus to allow for its superior retraction. A lamina spreader can be used to externally rotate the lateral displaced split fragment, exposing the inside of the joint. The iliotibial band and soft tissues need not be removed from that fragment. LATERAL MENISCUS IMPACTED ARTICULAR SURF