PMC5624166_01
Anteroposterior (a), lateral (b), and oblique (c and d) radiographs of the patient's right knee.
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fig1
Radiographic findings of a fracture involving the tibial plateau (Figure 1) were clarified on computed tomography, demonstrating coronal (Figures 2(a) and 2(b)), sagittal (Figure 2(c)), and axial (Figures 2(c) and 2(d)) components to her injury.
Sagittal, coronal, and 3D reformatted CT images of the right knee demonstrating the coronal fracture medially in the metaphysis (a), laterally in the epiphysis (b), sagittal fracture lines (c), and the rotational component in the axial plane (d).
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fig2
Radiographic findings of a fracture involving the tibial plateau (Figure 1) were clarified on computed tomography, demonstrating coronal (Figures 2(a) and 2(b)), sagittal (Figure 2(c)), and axial (Figures 2(c) and 2(d)) components to her injury. Three-dimensional (3D) reformats illustrated the two-fragment triplane fracture (coronal at the level of the epiphysis, sagittal at the metaphysis, and axial at the physis) and was notable for the internally rotated displacement of the tibial metaphysis relative to the proximal physis (Figure 2(d)).
Intraoperative images of closed reduction (a), percutaneous fixation (b), and compression (c) of the right knee.
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fig3
Under fluoroscopic guidance, a closed reduction was performed by traction, extension, and external rotation of the tibial shaft relative to the proximal physis (Figure 3(a)). The articular surface was compressed and held using partially threaded 7.3 mm cannulated screws in the epiphysis (Figures 3(b) and 3(c)).
Arthroscopic confirmation of the tibial plateau joint line reduction with a 3.4 mm hook probe (Arthrex, FL, USA) in the foreground.
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fig4
A diagnostic arthroscopy was performed, confirming the articular surface reduction (Figure 4) and excluding concomitant injury to the ACL, tibial spine, and menisci and the presence of osteochondral fragments.