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Original Research

Ann Med Res. 2005; 12(2): 71-75


An Alternative Technique for Prevention of Lateral Tibial Plateau Fractures During The Proximal Tibial Medial Opening Wedge Osteotomy: An Experimental Study At Calf Tibiae

 

İrfan Esenkaya*, Nurzat Elmalı*, Mesut Mısırlıoğlu*, Kadir Ertem*

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Abstract


 

 


Aim: Aim of this study is to define a simple method for preventing lateral tibial plateau fractures performing proximal tibia medial opening wedge osteotomy.  

Materials ve Methods: 30 calf tibiae in the same age and weight group were used for the experiments. They were assigned randomly into two groups. Of the 30 specimens, 15 were selected randomly as Group A. Five of them were divided in two equal parts on frontal plane with a large saw in order to observe the efficiancy of the procedures. Others were undivided. In this group, one or two provisional Kirschner wires or Schanz screws were applied 1.5-2 cm below and paralel to the articular surface. Later, oblique or nearly oblique osteotomies were performed medio-laterally 2 cm medial to the lateral cortex and 1.5 cm and 3 cm below the lateral tibial plateau. Following osteotomy, distractionwas made with angle-scale distractor. Of the 30 specimens, 15 were selected randomly as Group B. Five of them were divided in two equal parts on the frontal plane with a large saw. Others were again undivided. Oblique or nearly oblique osteotomies were performed medio-laterally 2 cm medial to the lateral cortex and 1,5 cm and 3 cm below the lateral tibial plateau. Following osteotomy, distraction was made with angle-scale distractor.

Results: In Group A where  the osteotomies were more distant from the articular surface and lateral cortex, no problem was seen during the first stage where the angle of distraction was mean 9.0º. Application above the mean angle of  9.0º of distraction created fracture line proximally but these lines could not pass  the level of provisional Kirschner wires or Schanz screws. The fracture lines  extended to the lateral cortex under the Kirshner wires or Schanz screws. Tibial plateau fracture was not observed. However in Group B osteotomy was made 3 cm distally from the articular surface and 2 cm medially from the lateral cortex, no problem was seen during the first stage where the mean angle of  distraction was 9.1º. In these specimens fractures reached tibial plateau or lateral cortex above the mean of 9.1º of distraction manoeuvres.

Conclusion: K-wires or Schanz screws applied paralel to the articular surface of tibial plateau guide the fracture line the lateral cortex and prevent intraarticular fracture formation on the plateau.

Key Words: Proximal tibial osteotomy, High tibial osteotomy, Complications, Experimental study, Lateral tibial plateau fractures, Technical trick







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