Osteochondral avulsion fracture of the posteromedial tibial
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Posteromedial tibial plateau avulsion fracture caused by semimembranosus muscle is not easy to detect by X-ray. Here presents the case of a 23 years old male reported a knee injury. At the physical examination he presented a swelling of the knee and a severe and permanent pain during weight-bearing, on the affected leg. Moreover, he reported knee instability with episodic ROM gap when trying to improve flexion.

X-ray evaluations presented a posteromedial tibial plateau fracture with a disruption of a bone portion in association with an anteromedial detachment of a bony fragment. A 3D CT scan was realized to define the exact position and dimension of the fragment that was rotated at 90° in the sagittal plane with the articular surface oriented anteriorly.

Surgery technique

Surgery was performed under general anesthesia. Surgeons opted for direct and open surgery access, since the injury was a true articular bony lesion. A posteromedial approach to the knee was performed through a curved incision from medial femoral epicondyle to the posteromedial tibial border with the knee slightly flexed. After fascia incision, the conjoined medial knee tendons were identified and exposed and the articular capsule was dissected between menisci and tibial plateau rim. At this point, the osteochondral fragment was visualized, and fracture surface was debrided. The avulsed fragment was de-rotated and reduced in its original position without reattachment of semi membranous fiber to obtain a good stability in all directions.

Once the fragment was reduced in its anatomical position, the stability of the osteochondral piece was excellent in the coronal and axial planes in reason of the intrinsic stability ensured by the subchondral surface. After the reduction with 2 K-wire , surgeons synthesized the fracture with 2 HCS screws (2,4 × 3,0 mm), directed superoinferiorly from lateral to medial, independently of distal femoral condyles impediment. The anteromedial depression fracture was reduced with 3 HCS screws inserted through the same surgical approach. The posterior articular capsule was sutured with Vicryl # 1 simple interrupted stitch. Knee was then immobilized with an adjustable knee brace at 20 degrees of flexion.

Conclusively, an uncommon clinical case about posteromedial tibial plateau avulsion fracture and the surgical technique applied to treat the lesion is described here. Osteosynthesis, like the one this case has shown, is optimal for this fracture especially in reason of the obtained clinical results.

Source: https://www.sciencedirect.com/science/article/pii/S2352644020300054
Dr. S●t P●l
Dr. S●t P●l Orthopaedics
Nicely managed
Mar 13, 2020Like