Innovative Use of Posterior Vertebral Wall Impactor in Tibial Plateau Depressed Fractures.

Abstract

Depressed articular fractures of tibial plateau are treated by elevation of the fracture fragments to maintain the articular congruity and filling the void with any bone substitutes, followed by screw or plate fixation. This elevation of the fragments to maintain articular congruity poses a surgical challenge even in experienced hands. Many techniques have been described for the same, as the use of the metallic-bone-tamps, elevators and more recently inflatable-balloon-tamps. But due to the lesser cross-section area, these often led to comminution of the fragile articular bone fragments. The inflatable-balloon-tamp caused extrusion of contrast-dye or unintentional posterior-wall displacement. We treated a series of 25 patients with tibial plateau depressed fractures by a novel technique using posterior-vertebral-body-wall-impactor. This helped in a uniform dissipation of force over a large cross-sectional area under the fracture fragment, leading to minimal comminution of the depressed fragment, maintaining the articular congruency. Rest of the fixation was done in the standard manner. There were no intra-operative or post-operative complications. All patients had good knee function according to Rasmussen Knee Function Grading System and achieved radiological union of fracture at follow-up (with a range of 12-18months). Hence, this technique may be a safer and effective alternative for the elevation of depressed articular fractures of tibia.