A 45-year-old man suffers a tibial plateau fracture in a road traffic accident. CT scan shows a lateral plateau depression of 12 mm with a split-depression pattern (Schatzker Type II). What is the standard surgical principle for restoring articular congruence?
- A Elevation of the depressed articular fragment through a metaphyseal window, bone grafting of the void, and buttress plate fixation ✓
- B Arthroscopic-assisted elevation and percutaneous screw fixation only
- C Primary total knee replacement
- D Closed reduction and long-leg cast for 8 weeks
Explanation
Schatzker Type II tibial plateau fractures involve lateral condyle split with central depression; surgical correction requires opening a cortical window below the depression, elevating the depressed articular cartilage using a bone tamp, filling the subchondral void with bone graft or substitute (to prevent re-depression), and applying a lateral buttress plate to prevent the split fragment from displacing. Arthroscopic assistance is a useful adjunct but not sufficient alone for high-energy depressions; primary TKR is not indicated in acute trauma in a middle-aged patient; closed management leads to incongruence and early osteoarthritis.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.