Three-Step Arthroscopy-Assisted Reduction and Internal Fixation for Schatzker IV With Lateral Depression Pattern (AO 41B3.3) Tibial Plateau Fracture-Dislocations

Abstract

Tibial plateau fracture patterns characterized by posteromedial (PM) column split, anterior cruciate ligament (ACL) bony avulsion, and posterolateral (PL) depression can constitute a tibial plateau fracture-dislocation with loss of correct femoral-tibial congruence. Managing these fracture-dislocations requires the reduction and fixation of the PL depression, the PM fragment, and ACL bony avulsion. PL depression with lateral meniscus entrapment often compromises the reduction of the PM column, which results in residual subluxation of the tibial plateau. This Technical Note describes a 3-step arthroscopy-assisted reduction and fixation of tibial plateau fracture-dislocations characterized by PM split, PL depression, and ACL avulsion. In the first step, PL depression arthroscopy-assisted reduction and temporary fixation is performed, and then an open posteromedial approach is used to reduce and fix the PM column split; finally, the PL tibial plateau is fixed with cannulated screws, and an arthroscopic ACL suture fixation is performed. The advantage of this technique is that the first arthroscopic step reduces the PL depression and manages the lateral meniscus, permitting proper PM column fixation in the second step, and the third step stabilizes the PL depression and repairs the ACL avulsion, ensuring anatomic reduction and fixation of the fracture and joint congruence.