Description
In this presentation, Michael Kelly, speaking on behalf of the Orthopedic Trauma Society, discusses tibial plateau fractures and outlines his approach to these complex injuries. He emphasizes the importance of restoring both the width and height of the plateau to match the condylar width effectively. Michael uses the Lyle classification to contextualize different fracture types, explaining the three-column structure comprising two anterior columns (medial and lateral) and a posterior column.
He details his surgical strategy, which involves making two standard incisions to access various structures, and discusses the evaluation of fractures through axial and sagittal imaging to guide fixation techniques and ensure the integrity of the articular surface. Michael highlights key points for restoring height and width effectively, stressing the need to first elevate impacted fragments and remove blocking pieces before addressing width.
In handling different fracture patterns, Michael notes that implant choices are influenced by the specifics of the fracture, such as the presence of medial cracks which may necessitate more robust locking plates. He elaborates on the management of two-column injuries and complex metaphyseal fractures, advocating for a meticulous approach that leverages principles similar to those used for plateau fractures.
Throughout his talk, he reiterates the need for clear intraoperative views and the importance of restoring mechanical axes for optimal recovery. His focus is on achieving stability using simple methods, favoring buttress and compression kits while recognizing that in certain cases, more robust fixation systems may be required. He closes by expressing his gratitude to the Orthopedic Trauma Society for the opportunity to present.