title: Metaphyseal tibial level (MTL) screws: a modified percutaneous technique for lateral plateau depression fractures.
abstract: BACKGROUND
  Lateral tibial plateau fractures are more frequent than medial fractures, and those with articular depression are particularly challenging because of high displacement risk. To prevent secondary subsidence, the gold standard is raft screws with a periarticular or anti-glide plate. Graft is used to fill the metaphyseal defect created by reduction in the depressed fragment. We present a case of Schatzker II fracture managed in a complete percutaneous fashion, with a new combined technique of raft screws and interference screw used as a support.
  
  
  METHODS
  A 51-year-old female sustained a Schatzker II tibial plateau fracture. Based on pre-operative CT, direction of reduction force to apply was drawn on coronal and sagittal cuts.
  
  
  METHODS
  Under fluoroscopic control, the split component of the fracture was reduced. The cortical window was then drilled in the lateral cortex, and a K wire advanced under the depressed fragment under fluoroscopic guidance. After fragment reduction with a bone impacter, internal fixation was completed by percutaneous introduction of two subchondral cortical screws. A bioabsorbable interference screw was then introduced in the impacter tunnel to support impacted bone under the reduced articular surface. Finally, a cortical screw was introduced, from anterior to posterior to prevent screw cut-out.
  
  
  CONCLUSIONS
  The combination of subchondral screws in a jail technique with a bioabsorbable interference screw that we named metaphyseal tibia level (MTL) screw technique is, to our knowledge, not described. The MTL screw promises to be a true percutaneous reduction and fixation technique for Schatzker II and III fractures in patients with reasonable bone quality.
authors.affiliation: Département de l'appareil locomoteur, Service d'orthopédie et traumatologie, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, BH 10-238, 1011, Lausanne, Switzerland, frederic.vauclair@chuv.ch.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Vauclair
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Almasri
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gallusser
authors.forename: Hans
authors.initials: H
authors.lastname: Van Lanker
authors.forename: Rudy
authors.initials: R
authors.lastname: Reindl
mesh_terms: D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D015641:Radiography, Interventional; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*