Reduction of Depressed Tibial Plateau Fractures Using Balloon Tibioplasty

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Reduction of Depressed Tibial Plateau Fractures Using Balloon Tibioplasty

Depressed tibial plateau fractures

Depressed tibial plateau fractures can be difficult to treat and current reduction techniques often lead to poor results. The commonly encountered fracture patterns are split with depression and pure lateral depression fractures (Schatzker type II and III), the later seen predominantly in older patient with osteoporotic bone. The treatment of choice for this type of fractures is considered to be open reduction and internal fixation. Elevation of the depressed fragment is necessary in order to restore articular congruency. Nevertheless the use of standard reduction techniques involves opening a bone window in the tibia and reducing the depression using a metal tamp and manual force. However this may result in worsening the defect and even articular penetration as the surface of the impact is small and the force applied is uneven. Borrowing from the successful vertebral kyphoplasty technique, we used an inflatable balloon as a tamp, to reduce a depressed tibial plateau fracture. This gave us the advantage of reducing the bone window to a drill hole.The technique has the advantages of minimal surgical trauma and widespread reduction force, resulting in a more congruent articular surface. The operation was completed with calcium phosphate cement augmentation of the bone defect and screw fixation of the plateau fracture.

balloon tibioplasty 1 — Figure 1 Clinical presentation, X-ray and CT scan.

balloon tibioplasty 2 — Figure 2 Operative room and draping, trocar and supporting K-wires introduction.

balloon tibioplasty 3 — Figure 3 Balloon inflation and fracture reduction (outlined by the red line).

balloon tibioplasty 4 — Figure 4 Fracture supporting K-wires, balloon deflation, and screw fixation.

balloon tibioplasty 5 — Figure 5 Cement injection for fracture augmentation.

Balloon Tibioplasty for Elderly Osteoporotic Patient

We presented the use of a new technique (balloon tibioplasty) for the reduction of a depressed tibial plateau fracture in an elderly osteoporotic patient. We found the technique to be easily applicable and effective in reducing the depression as well as minimally invasive. We achieved excellent results without any complication during or after the operation. The technique therefore appears to be a promising alternative to standard reduction options for this type of fracture in the elderly, leading to better results and lesser surgical trauma.

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