Tibial Fracture: Joseph Schatzker - Cheh Chin Tai 24/7/2003

CORR 1974; 105: 220-239

Compression in the surgical treatment of fractures of the tibia - Joseph Schatzker

The paper broadly speaking can be divided into four related sections; the first part is about the general principles of the tibia fractures fixation and stabilisation, and how the principles are subsequently applied to the three different parts of tibial fracture.

Principles of fracture care:

‘anatomical reduction and absolute fixation’ & ‘ functionally stable internal fixation’ – fractures stabilised by means of internal fixation under compression are so rigid that early mobilisation of both muscles and joints of the injured extremity is possible without discomfort and without the risk of interfering with bone union. This is achieved by means of lag screw, neutralisation plate, buttress plate, tension band plate, external compression clamps etc. supplemented with bone graft when a bone defect is present.

Proximal tibia fracture:

Surgical approach: vertical portion of the incision begins just proximal to tibia tubercle, 3-5 mm lateral to the anterior crest of the tibia.

Type I: more common in young people, frequently the meniscus is detached peripherally and trapped in the fracture. Treatment: cancellous lag screws X 2 passed over washers and reattached meniscus peripherally. Post-op: immobilised in 40-50 ° flexion on a splint. Motion starts within the first week. Weightbearing is withheld until union is sound

Type II: reduction of depressed fracture with bone punch and autogenous cancellous bone grafting, supported by buttress plate with 1 or 2 lag screws thru the plate for lateral wedge. Aim for slight over-reduction.

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