🤑 Tibia - Wikipedia

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The tibia is the major weight-bearing bone of the lower leg (picture 1 and picture 2). The proximal portion of the bone, the tibial plateau, forms the.


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Die proximale extraartikuläre Tibiafraktur | SpringerLink
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Triplane fracture of the proximal tibia: a case report and literature review
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EZ IO Placement

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The A.L.P.S. Proximal Tibia Plating System represents the next generation in anatomic locked plating of tibial plateau fractures. The low profile plates are.


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Monoaxial locking plate system for treating proximal tibia fractures. Plating that fits. Every minute counts in the.


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Ilizarov in Shatzker VI tibial condyle fractures

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Monoaxial locking plate system for treating proximal tibia fractures. Plating that fits. Every minute counts in the.


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Tibial Plateau Fracture Fixation, Proximal Tibia - Everything You Need To Know - Dr. Nabil Ebraheim

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The 3-proximal holes plate is recom- mended when there is a higher concern for supporting the tibial plateau. (e.g. severe intra-articular comminution). Plate head​.


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Posteromedial Technique for Management of Tricondylar Tibial Plateau Fractures

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Monoaxial locking plate system for treating proximal tibia fractures. Plating that fits. Every minute counts in the.


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Modified Posterolateral approach to the proximal tibia without fibular osteotomy (Forsche approach)

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The A.L.P.S. Proximal Tibia Plating System represents the next generation in anatomic locked plating of tibial plateau fractures. The low profile plates are.


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POSTEROMEDIAL APPROACH TO PROXIMAL TIBIA

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Get more information on the mm VA LCP® Proximal Tibia Plate developed by DePuy Synthes. Combines locking screw tech with conventional techniques.


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Tibial Plateau - Anterolateral and Posteromedial Approaches

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MB and FB. MUTARS® proximal tibia MK. MUTARS® GenuX® MK stems femoral and tibial length: mm*. Ø mm cemented. Ø mm cementless.


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Arrow® EZ-IO® System - Proximal Tibia Site Identification and Needle Insertion (Adult, Alert)

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). •. The goal is to make a rectangular space between the proximal tibial and distal femoral cuts (Fig. ).


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Proximal Lateral Tibia - Lateral Tibia Head Buttress Locked Plate

After reduction, fixation can be performed using a proximal anterolateral tibial locking compression plate LCP , anterolateral proximal tibial rafting LCP or lateral proximal tibial less-invasive stabilisation system LISS-plate Fa. However, if a second posteromedial or lateral incision is planned, care must be taken not to create an island of devascularised skin. Rehabilitation protocols should be carefully planned according to the degree of stability achieved by internal fixation, bone mineral density and other patient-specific factors age, compliance, mobility. If there are solitary fragments that can be fixated by screw osteosynthesis, a plate might not be necessary for fixation. Conversely, a low-energy mechanism may lead to a pure depression fracture in the older population who have reduced bone density. If performing screw osteosynthesis, stability of the elevated articular surface can be increased with a jail-type configuration of screws. Most posterocentral partial tibial head fractures can be reduced via a posteromedial or posterolateral approach, depending on the morphology of the fracture.

Partial tibial plateau fractures may occur as a consequence of either valgus proximale tibia varus trauma combined with a rotational and axial compression component. Classifying tibial plateau fractures by ten segments in a CT model may help to choose an appropriate approach.

In the non-osteopenic tibial bone, unicompartmental fractures of the medial column are rare. However, avulsions of the posterior cruciate ligament often involve larger fragments.

As a sign of a perfect reduction, the meniscus should then be in its normal position f. Three-dimensional 3D pre-operative imaging Proximale tibia scans with two-dimensional proximale tibia and 3D reconstructions is essential to fully understand the fracture morphology and may therefore influence the treatment strategy.

Lateral view of the knee. The perfect read article should have high osteo-inductivity, osteogenicity and osteoconductivity.

Conventional anterolateral arthrotomy is suggested to visualise the joint. First, dissection of the cavity between the head of the lateral gastrocnemius and the soleus muscle is conducted Fig. However, this decision should be considered carefully, as an angular stable plate provides increased stability and decreases the risk for secondary axial or horizontal displacement of fragments. The medial border of the gastrocnemius muscle is palpated, bluntly prepared and carefully retracted laterally. After subperiostal dissection of the popliteus muscle, the posteromedial tibia can be approached. This approach can be easily extended both proximally and distally, and implant removal may be performed with little operative morbidity. Once joint congruity is restored, bone grafting and screw osteosynthesis e can be performed. Although anteromedial partial proximal tibial fractures are rare, 5 this approach may help to reduce and fix posterior or lateral partial tibial head fractures using retrograde K-wires or cannulated screws. Using a raspatory, subperiostal dissection of the popliteus muscle is performed and the semi-membranosus complex is retracted medially Fig. The posterolateral lateral One-third of all AO type B fractures included central segments of the tibial spine. Holding the popliteus muscle cranially enables access to the posterolateral plateau. The depressed region is accessed through an anteromedial approach using a hollow trephine c, d in order to minimise bone loss. Femoral epicondylar osteotomy FE is a safe distance from the common peroneal nerve PN. A bone tamp is then used to elevate the depressed area under direct arthroscopic visualisation. Jail-type of screw configuration b in osteosynthesis may increase the maximum load and decrease cut-out failure vs conventional screw reconstruction a. Unicondylar lateral tibial plateau fractures were most common A possible reason for the relatively increased involvement of the lateral tibial plateau Fig. A high-energy traumatic mechanism may result in a more complex and multi-fragmented fracture pattern, which predominantly occurs in young people. The risk for compartment syndrome might be higher in comparison with conventional open reduction techniques. This situation leads to axis malalignment and pathological load distribution, which ultimately causes poor functional outcome and post-traumatic osteoarthritis. Thus, the vision can be extended by performing an osteotomy of the fibula, 13 , 14 the lateral femoral epicondyle 15 , 17 or a combined submeniscal approach to better address the posterior fragments. To improve access to the posterolateral parts of the tibia in posterior partial fractures, a modified posterolateral approach may be helpful. Posterior cruciate ligament avulsion fractures of the tibial head are not considered to be partial tibial head fractures by the authors of this article. A conventional anterolateral approach may be used for reduction and fixation of the anterolateral part of the tibial plateau. Provided by Weimann et al 29 and used with permission from BioMed Central. The meniscus is elevated proximally b as a typical sign for this posterolateral depression fracture. Fractures can be fixed using a posterolateral tibial LCP, a small 3. Different techniques have been described to reduce posteromedial tibial head fractures. This procedure completely exposes the medial tibial condyle and the fracture may be fixed using screw osteosynthesis, small 2. Soft-tissue damage, joint depression and fragment dislocation, as well as bone stock, patient compliance and concomitant injuries, may influence decision-making. In the following article, we focus mainly on unicompartmental AO type B1-B3 fractures. When managing impression fractures with loss of bone spongiosa substance, often bone substitutes are required to fill dead spaces. However, this technique is technically demanding and requires additional set-up. In a prone or side-lying position, the incision is performed longitudinally along the medial head of the gastrocnemius Fig. To reduce extended anterolateral and posterolateral partial tibial head fractures, the conventional anterolateral approach may not provide enough vision of the whole fracture. However, due to these difficulties, a clear treatment strategy is required to achieve an anatomical reduction and, subsequently, an optimal clinical and functional result. Fibular head FH osteotomy also mobilises the distal biceps femoris insertions but the PN must be secured. The femoral epicondylar osteotomy 15 has a lower risk for neurovascular damage compared with the proximal fibular osteotomy. Additionally, if clinical examination is difficult, a pre-operative MRI scans may be necessary to visualise concomitant intra-articular pathologies e. The medial tibial surface can be easily approached after performing a longitudinal skin incision. Autologous, allogenic and synthetic bone substitutes can be used to fill bone defects. The typical valgus and varus bending mechanism can result in a corresponding lateral or medial plateau split fracture with a varying degree of articular surface depression. A modified posterolateral approach between the soleus and the lateral head of the gastrocnemius 2 , with blunt preparation of the popliteus muscle held cranially enables access to the posterolateral plateau. For the posteromedial approach, the skin incision is performed along the medial head of the gastrocnemius. Other osteotomy-like techniques for extended approaches of the tibial head have been reported Fig. When an increase in soft-tissue damage is expected, fracture reduction should be performed either immediately before swelling of the limb, or the limb should be immobilised by cast or external fixator to condition the soft-tissue prior to secondary surgical reduction. However, due to a high risk of ligamentous and neurovascular damage, the indications for osteotomy should be evaluated carefully. After fracture reduction, the epicondylar bony wafer can be re-positioned by one or two cancellous screws and washers. Partial tibial plateau fractures may occur as a consequence of a valgus or varus trauma combined with a rotational and axial compression component. After blunt preparation, the semi-membranosus complex can be retracted medially and the medial gastrocnemius can be retracted laterally. The following specific indications for surgical treatment have been reported in the literature: 11 , In addition to the general condition of the patient, soft-tissue damage and swelling should be taken into consideration when planning surgery. Based on their findings, a new classification system was developed that included implications for the treatment strategy. Schatzker type III fractures a zero column fractures; pure depression can often be treated using arthroscopic reduction and internal fixation. Injury ;, with permission from Elsevier. A variety of minimally invasive approaches, temporary osteotomies and novel techniques e. Operative planning includes the simultaneous use of the arthroscopic instruments, as well as a C-arm for detailed visualisation. In the elderly, low-energy trauma and impression fractures are indicators for the further screening and treatment of osteoporosis. Synthes, Switzerland. DOI: Originally published online at www. In general, surgical reduction and fixation is indicated for most tibial head fractures. However, in the well-mineralised tibial head, fractures of the medial compartment appeared more often in multi-part tibial-head dislocation-type injuries. If in doubt, a saline solution joint injection may help to clearly identify the capsule. However, in some cases, the anterolateral approach does not provide full visualisation, especially of the posterior portion of the fracture zone. Epicondylar osteotomy is then performed circumferentially using a small osteotome and a micro-sagittal saw to create a bony wafer of 4 cm in diameter and 1 cm in depth. When incising the dorsal capsule, care must be taken not to injure the posterior cruciate ligament. However, recent CT-oriented classification systems provide more detailed information pertaining to the fracture morphology, degree of joint depression and appropriate surgical approach. Intra-articular pathologies meniscus and cartilage damage can also be evaluated and addressed, if necessary. Concomitant ligament disruption, meniscus or cartilage damage will further weaken clinical results. The meniscotibial ligaments should be incised horizontally, and the lateral meniscus should be slightly lifted proximally to gain sufficient view of the tibial joint surface. AO type B fractures showed a wide range of different fracture patterns with 29 different segment combinations overall. Non-operative treatment may be considered for non-displaced intra-articular fractures of the lateral tibial condyle. Concomitant ligamental injury with resulting instability should be identified before or during surgery. High-energy trauma may result in a more complex and multi-fragmented fracture pattern, which occurs predominantly in young people. Thus, a fibular osteotomy, 13 , 14 lateral femoral epicondylar osteotomy 15 or posterolateral approach may be necessary. Images created with Essential Anatomy 5, 3D4 Medical. Three-column fixation for complex tibial plateau fractures. Most partial tibial head fractures affect the lateral plateau. Conversely, a low-energy mechanism may lead to a pure depression fracture in the older population with weaker bone density. A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. The common peroneal nerve is exposed and is protected until the surgery is finished. To avoid stiffness, early functional mobilisation plays a major role in rehabilitation.