PMC5779779_01
Preoperative plain radiographs and CT scans. A: AP and lateral views showing an AO type 41-B3 fracture. B: Axial CT scan showing a depressed fracture fragment of the posterolateral quadrant combined with a split fracture fragment of the posteromedial quadrant. C: Coronal CT demonstrating an avulsion fracture of the tibial intercondylar eminence. D: Reconstructed CT scan.
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F1
At admission, X-rays revealed an AO type 41-B3 fracture (Fig. 1A). CT demonstrated a depression fracture of the PL quadrant combined with a split fracture of the PM quadrant and an avulsion fracture of the tibial intercondylar eminence (Fig. 1B-D).
Postoperative X-rays. A-B: AP and lateral views showing reduction of the fractures. C-D: X-rays at postoperative 5 months revealed that fracture lines were blurred and calluses had formed.
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F3
The lateral half of the AL quadrant was cut off longitudinally with a bone-chisel (Fig. 2A-C). The PL depression fracture was visible (Fig. 2D) and elevated to the joint line level by a small rod.
Osteotomy of the tibial plateau. A: Design of the osteotomy (shaded egion). O, center of the knee; A, anterior tibial tuberosity; B, posteromedial ridge of the proximal tibia; C, most anterior point of the fibular head; D, posterior sulcus of the tibial plateau. B: Axial CT at the subchondral level showing the osteotomy (shaded region). C: Intraoperative photograph of the osteotomy. White arrow, bone segment created by osteotomy. D: Photograph after osteotomy. White arrow, depressed articular surface.
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F2
After reduction, the PM fragments were fixed with a plate (Synthes GmbH, Umkirch, Germany) (Fig. 3A). Then, the AL fragments and the bone segment created by the osteotomy were fixed with a proximal lateral tibial plate (Synthes GmbH) (Fig. 3B). Postoperative X-rays revealed good reduction of the fractures (Fig. 3A, B). At postoperative 5 months, X-ray showed that fracture lines were blurred and calluses had formed (Fig. 3C, D).