56-year-old man received trauma of right knee joint at domestic conditions as a result of falling down from 4 m height. He was admitted by Ambulance at first in Ozurgeti City Regional Hospital where has been performed clinical, instrumental investigations and sufficient medical treatment and right lower extremity immobilization with cast. Patient then was transfered at Academician Z. Tskhakaia National Interventional Medical Center of West Georgia. At the moment of entering patient complained severe pain in the Right knee joint area, swelling, Right lower limb deformity. objective status: Right lower extremity was immobilized with cast. Severe swelling of the right knee joint. Expressed crepitation of bone fragments. Active and passive movement of the right knee (ROM) was severely Limited. The right lower limb neurological status was normal. Pulsation on Dorsalis pedis artery was normal. Clinical and roentgenography studies had shown:
Operative treatment was recommended, therefore patient was admitted to the trauma department. Operation was performed after 14 days from trauma, when soft tissue swelling, edema and excoriations on skin had gone and normal condition of soft tissues and skin has recovered in fracture zone. OP: Proximal tibia 41-C2 Indirect reduction with MIPO (Minimal Invasive Plate Osteosynthesis) technique. Angular stable plates, Less invasive stabilization system. Patient Position: Supine position. Surgical Approach: anterolateral approach
Irakli KhabeishviliThank You for your Opinions dear colleagues. Yes may be lateral condyle have still slight depression. But about using double plating with anterolateral and posterior medial planes in this type of fracture 41C2 was not necessary because in this case was used LCP locking plate. AO recommends fixation with only one plate not only 41C2 type of fractures, but even in 41C3 type of fracturesit has been said: «If one is using an angular stable implant (eg, LISS or the lateral tibial plate with locking screws) the application of a medial plate might not be necessary in a C3-type fracture if the medial cortex is not comminuted and is stable after lateral fixation». And if we use conventional plates yes i agree we must insure lateral plate with posteromedial conventional buttress plate.