الفهرس 
GENERAL OSTEOLOGY:Only 14 pages are availabe for public view
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Abstract
Many treatment alternatives are available for tibial plateau fractures, including casting, traction, closed reduction, and open reduction. No method can be used for all fractures. The decision to utilize one or more of these modalities is based upon a wide variety of considerations including the patients age, general condition, skin condition, associated injuries, type and severity of fracture, and the quality of knee function required by the patient, so each patient has to be individually evaluated. In the planning for the proper line of treatment two major considerations should be emphasized: Instability is an important feature of about 50% of tibial plateau fractures. *The function of the knee joint is proportionate to the accuracy of reduction, as the later is essential pre-requisite to get the knee back to its normal function and prevent post-traumatic osteoarthritis.
Recently arthroscopy play an important role in tibial plateau management .
Synergistic with intraoperative fluoroscopy and can be considered mainly for Schatzker’s types I to III provides good visualization of intra-articular soft tissues, aid to ensure proper articular congruity, probably the best method to repair posterior meniscal tear but its usage increase operative time. And must be avoided in high energy patterns.
Arthroscopy of the knee can be carried out as a purely diagnostic procedure, as the essential initial step before proceeding to operative arthroscopy, or before an open arthrotomy. The knee arthroscopy has its greatest diagnostic and intra-articular surgical application. Arthroscopic techniques have permitted documentation of the usefulness of the techniques in diagnosis and treatment of intra-articular pathology.
Locked plating has become popular and has biomechanical
advantages when compared with conventional plating. When combined
with minimally invasive surgical techniques,locked plating may cause
substantially less iatrogenic tissue damage .these characteristics may
make locked plating an attractive option for treating high energy
fractures of the tibial plateau and proximal tibia for which coverage
over the plate can be obtained.
High- energy tibial plateau fractures associated with sever soft
tissue injury are difficult to manage.the risk of wound complications
following open reduction and internal fixation is notably high owing to
extensive soft tissue dissection.Alternatively, application of circular
external fixator minimizes soft tissue dissection and provides adequate
fracture stabilization to allow early range of motion and correction of
any mal-alingment .with this technique ,soft tissue complications
particulary surgical site infections ar expected to be significantly
reduced.
The guiding principle in the post-operative care is early knee movement and delayed weight bearing until fracture healing is evident in a matter of 12 weeks. The idea of early movement is known to promote healing and regeneration of the damaged articular cartilage. The idea of delayed full weight bearing is to avoid collapse of the elevated tibial plateau.