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Total Depression Fracture

- See:
      - Medial Approach:
      - Post Operative Care and Compications:
- Discussion:
    - oblique frx that begins near intercondylar eminence & extends to cortex of medial or lateral tibial flare;
    - total depression is similar to Type IV Frx
    - TDF of medial plateau are prone to loss of position (esp w/ intact fibula)
    - medial plateau depressions of > 5 mm result in loss of nl valgus alignment or even varus alignment of the knee;
- Non Operative Treatment:
    - TDFof lateral plateau w/ < 5 mm of depression or displacement is treated w/ cast or cast brace;
          - long leg cast may not provide enough lateral support to prevent loss of frx reduction;
         - cast brace provides better support;
    - TDF of Medial Plateau:
         - w/ < 5 mm of depression or displacement, try closed reduction to bring  fracture fragment upto the normal articular level;
               - capsular attachments to displaced plateau will serve to reduce fracture when knee is placed in valgus;
- Operative Treatment:
    - PreOp Planning
    - 2 or 3 K wires with cannulated screws, for frxs of lateral plateau;
         - after percutaneous screw fixation, cast bracing is needed;
    - w/ > 5 mm displacement & an unstable knee, then butress plate is required;
         -  buttress plate is required for comminuted frxs of medial or lateral plateau;
         - T or L butress plates are contoured to shape of tibial flare w/bending irons and fixed with cancellous cortical screws;
- Post Operative Care and Compications:
    - TDF of medial plateau are prone to loss of position;
    - Loss of Reduction:
         - occurs in 20% of such frxs that were treated by closed means;
         - X-rays obtained every 14 days wil reveal any loss of position, and will allow correction of position

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