What is the treatment for type V and VI tibial plateau fractures?

Updated: Jul 05, 2018
  • Author: Srinivasa Vidyadhara, MBBS, DNB, MS(Orth), DNB(Orth), FNB(SpineSurg), MNAMS; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

Type V and VI tibial plateau fractures (see the images below) are usually due to high-energy forces and are often associated with compromise of the surrounding soft tissues. In these cases, extensible exposure of the upper tibia with subperiosteal placement of large implants should be avoided. This approach has been associated with an increased risk of wound dehiscence and infection.

Shown is a Schatzker type V fracture, with a displ Shown is a Schatzker type V fracture, with a displaced and depressed medial tibial plateau.
Type VI tibial plateau fracture undergoing biologi Type VI tibial plateau fracture undergoing biological fixation of the lateral condyle and external fixation of the medial plateau, resulting in an acceptable clinical and radiological result.
Type VI tibial plateau fracture with severe soft t Type VI tibial plateau fracture with severe soft tissue injury successfully treated with Ilizarov external ring fixator.
High-energy type VI tibial plateau fracture treate High-energy type VI tibial plateau fracture treated with bone grafting and double plating after the soft tissue condition improved.

Fractures involving both condyles routinely require repair. The plateau with the most severely involved articular surface should be plated first. The less involved side should be treated with minimal, biologic fixation using percutaneous implants, limited posteromedial incisions, or a small external fixator to minimize exposure and bone stripping. They are frequently comminuted, and the shaft may be dissociated with the metaphysis. Many of these fractures, portrayed in the images below, are better treated with external fixation.


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