胫骨髁间嵴骨折.ppt

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1、Arthroscopic Reduction and Internal Fixation of TibialEminence Fractures once thought to occur only in the pediatric population,in adults as well.Fractures of the tibial intercondylar eminence The ability to arthroscopically 1.evaluate the fracture pattern 2.address concomitant intraarticular pathol

2、ogy.Cannulated screw fixation has been shown to have good strength and fracture stabilization.Existing problems1.smaller or comminuted fracture fragments2.The potential for hardware impingement with the subsequent loss of knee extension3.coupled with the possibility of screw removal suture fixation

3、is biomechanically stronger than screw fixation.Surgical TechniqueCreated a central transpatellar portala superior percutaneous 4.5-mm K-wire may be used to obtain provisional fixation.Surgical TechniqueA No.5 FiberWire is then shuttled through the base of the ACL with the SutureLasso.Surgical Techn

4、iqueThe ACL guide system is used to drill 2 parallel tunnels within the tibia.Surgical Techniqueunscrews and removes the inner drill bit while leaving the outer cannulated drill sleeve in place A Nitinol suture loop is then passed up through the outer cannulated drill bit into the knee.Surgical Tech

5、nique One end of the No.5 FiberWire is then shuttled by use of the Nitinol loop from the working portal down the medial tunnel and out the anterior aspect of the tibia.Surgical TechniqueThe other end of the No.5 FiberWire is shuttled in the same manner out of the second drill hole.The reduction is c

6、onfirmed,and the suture is then tied over a bony bridge on the anteriormedial cortex of the tibia.DiscussionArthroscopic has advanced to become the preferred method of treatmentThe addition of the cannulated drill significantly simplifies the process of suture passage while maintaining fracture reduction and minimizing surgical steps.