Surgical principles of treatment for tibial plateau fractures Obada B., Serban Al.O., Botnaru V., Alecu Silvana-Crina Orthopaedic-Traumatology Clinic of Constanta, Romania Objective The study aim to establish some clear principles of therapeutic approach, so as the current therapeutic moment not to become a simple stage to a future knee arthroplasty. Material. Methods. 64 tibial plateau fractures were studied from Jan 2012 to Dec 2013 and followed-up for minimum period of 6 months. The systematisation of the casuitry was made using Schatzker and AO classifications. Arthrosis risk was evaluated using Kellgren/Lawrence score. Functional evaluation of the knee was made using Lysholm score. Results. Discussions. Mandatory imagistic investigations for preoperative planning Xray, CT, CT3D, MRI Treatment objectives anathomic reconstruction stable fixation vascularity preservation early mobilisation Demographic profile Criteria No Mean age (years) 46 (20-67) Mean follow-up (month) 11 Sex (male/female) 39/25 Low /high energy trauma 19/45 Falling from height 34 Car accident 21 Other etiologies 9 Type 41B 36 Type 41C 28 MRI at 1 year after surgery Lateral meniscus lesions 53% Medial meniscus lesions 19% ACL lesions 21% Osteosynthesis methods Provisional ExFix 6 CRIF Cannulated screws 8 ORIF 1 plate nonblocking 16 blocking 13 2 plates 11 1 nonblocking + 1 blocking 10 Bone graft 14 Important aspects to consider Depression – submeniscal approach, checked in frontal and sagital view Correct width of the plateau after reduction – anathomic relation with condyles, butress effect of the plate Metaphiseal fixation – one plate for each columne (medial and lateral) Subchondral deffect – bone graft Soft tissue monitorisation (Schatzker V,VI and AO 41C) Crucial question – When is the optimal surgical moment? Delay period of time was between 7-12 days. Damage control Provisional external fixation ensure: bone and soft tissue stability control length, axis, rotation indirect reduction through ligamentotaxis Indications for ExFix: unstable fractures risk of compartmental syndrome soft tissue lessions Surgical approaches anterolateral, posteromedial, posterior Fracture 41-B1, Schatzker IV, postero-internal fragment. Locking plate osteosynthesis. 41-C2, Schatzker V, 2 locking plates. 6 months after surgery. Full weight bearing. 41-C2, Schatzker V –postoperative and at 6 months. 41-C3, Schatzker VI. ExFix, locking plate. 41-C3, Schatzker V. 2 locking plates. 3, 6 months after surgery. Algodistrophy Radiologic evaluation of arthrosis at 1 year after surgery 41-C2, Schatzker VI. ExFix, locking plate. 41-C3, Schatzker VI. 1 locking and 1 nonlocking plates. 6, 9 months after surgery. Functional evaluation of knee at 1 year after surgery 41-B3, Schatzker II. Locking plate and bone graft after 1 year. 41-C2, Schatzker V – 2 nonlocking plates at 1 year. 41-C2, Schatzker V – 1 locking and 1 nonlocking plates at 1 year. 41-B3, Schatzker II. Nonlocking plate, bone graft. Aspects at 1 year. Conclusions A correct surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion, reduce arthrosis risk and hence to achieve optimal knee function. The choice of optimal surgical methods, proper approach and implant is made personalised in relation to fracture type according Schatzker and AO classification. There is no significant difference reagarding arthrosis risk for the type B and C fractures. Arthrosis is generally well tolerated.