A tibial plateau depression fracture occurs when axial
forces from the femoral condyles against the articular surface of the tibia
cause the injury. The compression fracture may also be associated with other
fractures. Several techniques are used for the treatment of this fracture.
Balloon osteoplasty is proposed as a useful tool for reduction and elevation of
the tibial plateau depression fracture.
The technique of balloon osteoplasty can be done with or
without the supplementation of screws and plate fixation. Trajectory lines are
drawn on the medial side of the knee for access to the fracture area. A small
incision is made at the point where the lines cross. A cannula and trocar tip
stylet is used to access the fractured area under radiographic guidance. The
cannula and trocar is advanced under the area of depression using a mallet or
drill when needed. Once inserted, the trocar is then removed from the cannula.
The precision drill is then inserted into the cannula and advanced until it
passes under the depressed area of bone. Then, the precision drill is removed
from the cannula and the inflatable bone tamp is inserted through the cannula
to the area of the depressed fragments. The inflatable bone tamp is centered
under the area of depression and then inflated to reduce the depression
fracture. Once the depression has been adequately reduced, the inflatable bone
tamp can be deflated and removed from the cannula.
The void that has been left by the inflatable bone tamp is
now ready to be replaced with bone filler. The device loaded with injectable
material is inserted and used until the void is completely filled. Finally, you
will remove the injectable material device and the cannula. Plate fixation may
be added before or after the injectable material is inserted.
