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1、SurgicalManagementofTibialTubercleFracturesinAssociationWithTibialPlateauFracturesFixedbyDirectWiringtoaLockingPlateTechnicalTrickChakraverty,JulianKMBChB,DO*;Weaver,MichaelJMD†;Smith,RMalcolmMD‡;Vrahas,MarkSMD§ Fromthe*FrenchayHospital,NorthBristolNHSTrust,Bristol,UnitedKingdom;†HarvardC
2、ombinedOrthopaedicProgram,MassachusettsGeneralHospital,Boston,MA;and‡MassachusettsGeneralHospitalOrthopaedicsand§PartnersOrthopaedics,HarvardSchoolofMedicine,MassachusettsGeneralHospital,Boston,MA.Theauthorsdidnotreceivegrantsoroutsidefundinginsupportoftheirresearchorpreparationofthisarti
3、cle.Oneauthor(M.S.V.)hasreceivedanunrestrictededucationalgrantfromSynthesinsupportofhisfellowshipprogram.AlldevicesincludedinthisarticleareFoodDrugAdministrationapproved. PresentationofMaterial:notapplicable. Reprints:MarkS.Vrahas,MD,ChiefofOrthopaedicTrauma,PartnersOrthopaedics,Associate
4、Professor,HarvardSchoolofMedicine,MassachusettsGeneralHospital,55FruitSt,YAW3600-3C,Boston,MA02114.SummaryTibialtuberclefracturesdisruptingtheextensormechanismofthekneecanoccurinassociationwithcomplextibialplateaufractures(AOtype41A,B,C).Themanagementofthesefracturescanbedifficult;astable
5、repairofthetibialtuberclefragmentisessentialiftheextensormechanismistobereconstituted.Therearefewreportedtechniquesdescribedtomanagetibialtuberclefracturesinconjunctionwithcomplexproximaltibialinjuries.Traditionally,tibialtuberclefractureshavebeenrepairedbylaggingthetuberclefragmenttothep
6、osteriorcortexofthetibiausing1ormorescrews.However,thecortexoftheposteriortibiadoesnotalwaysoffergoodpurchaseforscrewfixation,particularlyinosteopenicbone.Additionally,incomplexproximaltibialfractures,comminutionoftenextendsposteriorly,furthercomplicatingstablelagscrewfixation.Placementof
7、ananteroposteriorlagscrewcanalsobecomplicatedbyscrewtrafficiftherearealargenumberofscrewsfixingtheprimaryfracture.Inthisarticle,wereportanovelsurgicalapproachforthemanagementoftibialtuberclefracturefragmentsoccurringinassociationwithcomplexproximaltibialfractures.Us
