胫骨结节骨折合并胫骨平台骨折采用锁定钢板联合直接钢丝固定解析.ppt

Surgical Management of Tibial Tubercle Fractures in Association With Tibial Plateau Fractures Fixed by Direct Wiring to a Locking Plate  Technical Trick Chakraverty, Julian K MBChB, DO*; Weaver, Michael J MD?; Smith, R Malcolm MD?; Vrahas, Mark S MD§From the *Frenchay Hospital, North Bristol NHS Trust, Bristol, United Kingdom; ?Harvard Combined Orthopaedic Program, Massachusetts General Hospital, Boston, MA; and ?Massachusetts General Hospital Orthopaedics and §Partners Orthopaedics, Harvard School of Medicine, Massachusetts General Hospital, Boston, MA. The authors did not receive grants or outside funding in support of their research or preparation of this article. One author (M.S.V.) has received an unrestricted educational grant from Synthes in support of his fellowship program. All devices included in this article are Food Drug Administration approved.Presentation of Material: not applicable.Reprints: Mark S. Vrahas, MD, Chief of Orthopaedic Trauma, Partners Orthopaedics, Associate Professor, Harvard School of Medicine, Massachusetts General Hospital, 55 Fruit St, YAW 3600-3C, Boston, MA 02114. Summary Tibial tubercle fractures disrupting the extensor mechanism of the knee can occur in association with complex tibial plateau fractures (AO type 41A, B, C). The management of these fractures can be difficult; a stable repair of the tibial tubercle fragment is essential if the extensor mechanism is to be reconstituted. There are few reported techniques described to manage tibial tubercle fractures in conjunction with complex proximal tibial injuries. Traditionally, tibial tubercle fractures have been repaired by lagging the tubercle fragment to the posterior cortex of the tibia using 1 or more screws. However, the cortex of the posterior tibia does not always offer good purchase for screw fixation, particularly in osteopenic bone. Additionally, in complex proximal tibial fractures, comminution often extends posteriorly, further complicat