Principios quirúrgicos en fracturas de platillos tibiales con compromiso de columna posterior

Pedro Díaz Allende; Maximiliano Scheu Gonçalves; Xabier Carredano González; Oscar Colmenares Sandoval; Claudio Yáñez Lagos; Rodrigo Donoso Martínez; Luis O'Connell Godoy; David Figueroa Poblete

doi:10.1055/s-0038-1641563

Revista Chilena de Ortopedia y Traumatología, Table of Contents

CC-BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2018; 59(01): 022-034
DOI: 10.1055/s-0038-1641563

Review Article | Artículo de Revisión

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Principios quirúrgicos en fracturas de platillos tibiales con compromiso de columna posterior

Surgical Principles in Posterior Column Tibial Plateau Fractures

Pedro Díaz Allende

¹Fellow Cirugía Artroscópica y Reconstructiva de Rodilla, Clínica Alemana de Santiago, Universidad del Desarrollo / Hospital Clínico Mutual de Seguridad de Santiago, Chile

,

Maximiliano Scheu Gonçalves

²Unidad de Rodilla, Clínica Alemana de Santiago, Chile

³Unidad de Rodilla, Hospital Clínico Mutual de Seguridad de Santiago, Chile

,

Xabier Carredano González

³Unidad de Rodilla, Hospital Clínico Mutual de Seguridad de Santiago, Chile

,

Oscar Colmenares Sandoval

¹Fellow Cirugía Artroscópica y Reconstructiva de Rodilla, Clínica Alemana de Santiago, Universidad del Desarrollo / Hospital Clínico Mutual de Seguridad de Santiago, Chile

,

Claudio Yáñez Lagos

⁴Traumatólogo Estadía en Capacitación en el Departamento de Ortopedia y Traumatología, Clínica Alemana de Santiago, Chile

,

Rodrigo Donoso Martínez

⁵Becado de Ortopedia y Traumatología, Clínica Alemana de Santiago - Universidad del Desarrollo, Chile

,

Luis O'Connell Godoy

⁶Médico-Cirujano. Estadía en Capacitación en el Departamento de Ortopedia y Traumatología, Hospital Clínico Mutual de Seguridad de Santiago, Chile

,

David Figueroa Poblete

²Unidad de Rodilla, Clínica Alemana de Santiago, Chile

› Author Affiliations

Abstract

Resumen

Las fracturas de platillos tibiales son lesiones complejas que incluyen una variedad de patrones morfológicos cada vez mejor caracterizados en la literatura. Históricamente, los esquemas de clasificación se han basado en evaluar los rasgos de fractura en el plano frontal y las técnicas quirúrgicas en lograr la fijación de esos fragmentos, sin tomar en consideración el compromiso óseo que ocurre en la región posterior de los platillos tibiales. Con el advenimiento de la clasificación columnar basada en tomografía computada, se han logrado desarrollar estrategias de fijación optimizada, dando cada vez más relevancia a la columna posterior. Este artículo realiza una revisión extensa de la literatura, otorgando los fundamentos quirúrgicos que explican la importancia del tratamiento específico de la columna posterolateral y posteromedial, con el fin de restablecer la biomecánica normal de la rodilla y el razonamiento quirúrgico de las diversas vías de abordaje específicas para una reducción y osteosíntesis satisfactoria de esos fragmentos.

Abstract

Tibial plateau fractures are complex injuries which include a variety of morphological patterns that have been increasingly better characterized in the literature. Historically, classifications have focused on description of fracture patterns in the frontal plane, while surgical techniques have focused on reduction of these fragments not considering the osseous defects that occur on the posterior region of the tibial plateau. With new CT scan column based classifications, strategies to optimize fixation have been developed, giving relevance to the posterior column. This article is an exhaustive review of the literature, providing the surgical foundations that explain the importance of specific treatment of the posterolateral and posteromedial column, aiming to restore normal knee biomechanics. Furthermore, this article provides the diverse specific surgical approaches rationale for a satisfactory open reduction and internal fixation of these fragments.

Palabras Clave

abordaje posterior directo - abordaje quirúrgico - columna posterior - columna posterolateral - columna posteromedial - fractura de platillos tibiales

Keywords

direct posterior approach - posterior column - posterolateral column - posteromedial column - surgical approach - tibial plateau fracture

Full Text

References

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