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1、SurgicalManagementofTibialTubercleFracturesinAssociationWithTibialPlateauFracturesFixedbyDirectWiringtoaLockingPlateTechnicalTrickChakraverty,JulianKMBChB,DO*;Weaver,MichaelJMD†;Smith,RMalcolmMD‡;Vrahas,MarkSMD§ Fromthe*FrenchayHospital,NorthBristolNHSTrust,Bristol,UnitedKingdom;†Harv
2、ardCombinedOrthopaedicProgram,MassachusettsGeneralHospital,Boston,MA;and‡MassachusettsGeneralHospitalOrthopaedicsand§PartnersOrthopaedics,HarvardSchoolofMedicine,MassachusettsGeneralHospital,Boston,MA.Theauthorsdidnotreceivegrantsoroutsidefundinginsupportoftheirresearchorpreparationof
3、thisarticle.Oneauthor(M.S.V.)hasreceivedanunrestrictededucationalgrantfromSynthesinsupportofhisfellowshipprogram.AlldevicesincludedinthisarticleareFoodDrugAdministrationapproved. PresentationofMaterial:notapplicable. Reprints:MarkS.Vrahas,MD,ChiefofOrthopaedicTrauma,PartnersOrthopaedi
4、cs,AssociateProfessor,HarvardSchoolofMedicine,MassachusettsGeneralHospital,55FruitSt,YAW3600-3C,Boston,MA02114.SummaryTibialtuberclefracturesdisruptingtheextensormechanismofthekneecanoccurinassociationwithcomplextibialplateaufractures(AOtype41A,B,C).Themanagementofthesefracturescanbed
5、ifficult;astablerepairofthetibialtuberclefragmentisessentialiftheextensormechanismistobereconstituted.Therearefewreportedtechniquesdescribedtomanagetibialtuberclefracturesinconjunctionwithcomplexproximaltibialinjuries.Traditionally,tibialtuberclefractureshavebeenrepairedbylaggingthetu
6、berclefragmenttotheposteriorcortexofthetibiausing1ormorescrews.However,thecortexoftheposteriortibiadoesnotalwaysoffergoodpurchaseforscrewfixation,particularlyinosteopenicbone.Additionally,incomplexproximaltibialfractures,comminutionoftenextendsposteriorly,furthercomplicatingstablelags
7、crewfixation.Placementofananteroposteriorlagscrewcanalsobecomplicatedbyscrewtrafficiftherearealargenumberofscrewsfixingtheprimaryfracture.Inthisarticle,wereportanovelsurgicalapproachforthemanagementoftibialtuberclefracturefragmentsoccurringinassociationwithcomplexproximaltibialfractur
8、es.Us
