Treatment of Schatzker Type III Tibial Plateau Fractures: Report of an Alternative, Percutaneous Technique and Brief Review of the Literature

Abstract

Schatzker III tibial plateau fractures (TPF) reduction and stabilization is still a challenging procedure. We present an alternative, percutaneous surgical technique. With an antero-medial transverse incision at the level of the tibial metaphysis, under fluoroscopic control, an osteotome is advanced from medial to lateral, under the depressed fragments, reducing the articular surface of the lateral TP anatomically, without create a significant void and preserving the lateral wall. Final fixation is achieved with screws placed from lateral to medial in a percutaneous fashion, parallel to the articular surface to hold fragments in a rafting way. Open surgical techniques hidden many pitfalls and several new reduction options have been described; some simple but invasive using bone tamps and bone graft that increase surgical trauma, others reliable and safe, but demanding and difficult to reproduce, needing good arthroscopic skills or special and expensive instrumentation, not always available in the operating theatre. We prefer a medially based percutaneous metaphyseal bone access using two simple flat low profile instruments such as osteotomes, that preserve bone and vascularization during the reduction maneuvers, minimizing the above mentioned risks, for the treatment of Schatzker type III TPF.