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Type III Tibial Plateau Frx


- See: Tibial Plateau Frx MenuLocal Compression Frx

- Discussion:
    - involves central or peripheral depression of frx of lateral plateau w/o associated lateral wedge fracture;
    - it usually occurs from minimal impact on weak osteoporotic bone;
    - commonly affects older age groups (55-60 yrs) w/ marked osteoporosis;
    - stability of joint is rarely affected & excellent function is expected if there is minimal joint incongruity;

- Radiographs:
    - degree of joint involvement may vary, from small central plateau depression to fracture depression involving the whole plateau;

- Non Operative Rx:
    - most low energy type III frx in elderly pts w/ poor bone stock should be treated non-operatively;
    - if no valgus instability is found, it is safe to treat such a frx, w/ early motion but no wt bearing;

- Operative Rx:
    - PreOp Planning
         - if surgery is planned, consider properative MRI;
    - w/ valgus instability, ORIF is considered;
    - if depression is severe, articular fragments should be elevated bone grafted, and the lateral cortex supported with a butress plate;
    - w/ central depression frx, lateral cortex is intact circumferentially, & theoretically, there is no need for butress plate;
    - consider arthroscopic visualization of frx, use of the ACL guide to assist with the creation of a bone window below the depression;
         - the ACL guide, can then assist with elevation of the depressed fragment;
         - bone graft is inserted from below, and following this a 6.5 mm cancellous screw is inserted below the graft to provide support;

- Post Op Care