title: Indirect reduction and percutaneous screw fixation of displaced tibial plateau fractures.
abstract: Indirect reduction and percutaneous screw fixation were attempted in 20 displaced tibial plateau fractures in 20 patients. Closed, indirect reduction was successful in 18 fractures; two others, both Schatzker type II fractures, required open reduction. The 18 fractures were followed for an average of 16.2 months (range, 12-24 months). Of the fractures successfully reduced with indirect techniques, 13 were reduced anatomically (72.2%), and five were considered nonanatomic (27.8%). Four of the five fractures with a nonanatomic reduction were type II fractures. Clinically, there were six excellent (33%), 10 good (56%), and two fair (11%) results. No fracture lost reduction; no patient developed an infection. Indirect techniques could effectively reduce only split fragments. Depressed fragments could not be reduced reliably with either ligamentotaxis or percutaneous elevation with a tamp. There was no correlation between radiographic reduction and clinical outcome. It did not matter whether two, three, or four screws were used to stabilize the fracture.
authors.affiliation: Hospital for Joint Diseases, Orthopaedic Institute, New York, NY 10003.
authors.forename: K J
authors.initials: KJ
authors.lastname: Koval
authors.forename: R
authors.initials: R
authors.lastname: Sanders
authors.forename: J
authors.initials: J
authors.lastname: Borrelli
authors.forename: D
authors.initials: D
authors.lastname: Helfet
authors.forename: T
authors.initials: T
authors.lastname: DiPasquale
authors.forename: J W
authors.initials: JW
authors.lastname: Mast
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000145:classification / Q000601:surgery*; D016896:Treatment Outcome