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J Knee Surg 2017; 30(06): 509-513
DOI: 10.1055/s-0036-1593366
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The “Hoop” Plate for Posterior Bicondylar Shear Tibial Plateau Fractures: Description of a New Surgical Technique

Vincenzo Giordano
1   Serviço de Ortopedia e Traumatologia, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
,
Joseph Schatzker
2   Department of Orthopedics, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
,
Mauricio Kfuri
3   Department of Orthopedics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
4   Department of Orthopedics, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
› Author Affiliations
Further Information

Publication History

30 November 2015

11 August 2016

Publication Date:
29 September 2016 (online)

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Abstract

High-energy fractures of the proximal tibia with extensive fragmentation of the posterior rim of the tibial plateau are challenging. This technique aims to describe a method on how to embrace the posterior rim of the tibial plateau by placing a horizontal precontoured one-third tubular plate wrapped around its corners. This method, which we named “hoop plating,” is mainly indicated for cases of crushed juxta-articular rim fractures, aiming to restore cortical containment of the tibial plateau. Through a lateral approach with a fibular head osteotomy (Lobenhoffer approach), both anterolateral and posterolateral fragments are directly reduced and supported by a one-third tubular plate of adequate length. The plate is inserted from lateral to medial deep to all soft tissues, and its position is checked with fluoroscopy. The implant sits exactly on the posterior cortex of the tibial plateau and provides containment for the reduced juxta-articular posterior cortex and rim. We begin with immediate range of motion. Toe-touch weight-bearing with crutches is allowed with the operated knee in full extension. Weight-bearing is gradually increased only after 6 weeks as bone healing is taking place. Clinical follow-up is performed at 1, 3, 6, and 12 weeks. If the radiological exam confirms that the fracture is healed, the patient is allowed to proceed to muscle strengthening and bear weight entirely. The “hoop plating” may be a good option for the management in cases of extensive posterior tibial plateau articular surface fracture and impaction with rim and posterior cortical wall fragmentation.

Keywords

bone plates - comminuted fractures - knee injuries - tibial fractures
 

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