Arthroscopic treatment of lateral tibial plateau fractures: a simple technique

We present a new technique for arthroscopic-assisted fluoroscopic treatment of external tibial plateau fractures (Schatzker type I, II, III), using custom-made instrumentation. The instrument includes 4 basic elements: 2 cutting guides, a hollow trephine cutter with a saw-toothed tip, and a bone plunger. The lateral plateau is restored from the opposite side. An anteromedial rectangular cortical window in the proximal diaphysis of the tibia is created using the cutting guides. To achieve the reduction, the hollow trephine cutter is introduced into the opening created. The bone plunger is inserted into the hollow trephine cutter until resistance is felt. At this point the cancellous bone is compacted by applying force onto the plunger with the hammer so as to obtain a strong compact bone carrot. The plunger then pushes it under the depressed area, filling it out and pushing it upward, creating an indirect reduction. The arthroscopy comes into play estimating the precise anatomic reduction of the articular surface of the tibia. No graft is necessary and cannulated lag screws fix and strengthen the reduction. This new technique is reproducible, easy, less invasive than others, and ensures a stable cartilage and subchondral support without the need for grafts.