Lima 08 platillos tibiales 2 de mayo
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Transcript of Lima 08 platillos tibiales 2 de mayo
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Abordajes quirúrgicos para Fracturas de los Platillos Tibiales
Renzo Ballón Manrique
Lima, noviembre 2014
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Objetivos
• Anatomía quirúrgica relevante.
• Importancia de los tejidos blandos.
• Mostrar los abordajes más frecuentes, para el tratamiento de estas fracturas.
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Anatomía
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Platillos Tibiales .
Altura relativa Inclinación posterior
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Ejes
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Ejes
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EjeMecánico
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Diagnóstico
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• No solamente 2 incidencias
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AP + Lareral
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¿Suficiente?
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Diagnóstico
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Caso Clínico
41 C3 IC2 MT5 NV1
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Clasificación
•Schatzker
•Grupo AO
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Schatzker
I II III IV V VI
Schatzker et al.,1979
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Grupo AO
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Grupo AO
4
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Grupo AO
4 14
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Grupo AO
4 14
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Grupo AO
4 1
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Grupo AO
4 1
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Grupo AO
4 1
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Tratamiento
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Princípios de Estabilidad
Estabilidadabsoluta
Estabilidadabsoluta
Estabilidadrelativa
Estabilidadrelativa
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Princípios de Reducción
ReducciónDirecta
ReducciónDirecta
ReducciónIndirecta
ReducciónIndirecta
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Reducción Directa
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Reducción Directa
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Reducción Directa
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Reducción directa
Paccola, 1998
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Indirecta + Directa
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Control de la Reducción
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Control Fluoroscopico en el plano frontal
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Abordaje
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Antero-lateral
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Póstero-Medial
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41 C1 Póstero-Medial
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Figura 4
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Incisão Cutânea
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Pata de Ganso
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Hohmann: Poplíteo
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Placa: Póstero-Medial
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25 anos, fem, politrauma
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25 anos, fem, politrauma
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Tomografia Computadorizada
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Tomografia Computadorizada
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Estratégia1.Póstero-medial
2.Ântero-lateral
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Póstero-Medial
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Antero-Lateral
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Antero-Lateral• Las vías de acceso
únicas, mediales para rotulianas, tienen un alto porcentaje de infecciones profundas (23-87%).
Moore y cols. J Orthop Trauma. 1987Young y Barrack Orthop Rev. 1994Vieri y cols, OTA abstract. 1999
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Fracturas bicondilares posteriores
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Fracturas bicondilares posteriores
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Fracturas bicondilares posteriores
Carlson, JBJS Am 1998
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Abordaje posterior (Carlson, 1998)
Medial
Lateral
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Fracturas bicondilares posteriores
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Carlson, JBJS Am 1998
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Abordaje
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Abordaje
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Nervio Fibular
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Sóleo
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Poplíteo
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Exposición
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Exposición
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Póstero-Lateral
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Indicaciones
• Hundimiento Póstero-Lateral
• Cizallamiento Póstero-Lateral
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OSTEOTOMIA DE PERONÉDESINSERCIÓN DEL COMPLEJO LATERAL
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Desinserción del complejo lateral
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SEAMOS HUMILDES Hay que saber pedir ayuda
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RAFI: Técnica MIPO41 B241 B2
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MIPO
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MIPO
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Placas + tutores
• Placa lateral
• Fijador medial
• Evitar el colapso en varo
• Apoyo medial durante 6 semanasBolhofner B.: CORR 1999, J Orthop Trauma 2001
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Placa + tutor
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MIPO
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MIPO
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MIPO
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Varón , 60 años, caída de altura
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Varón, 41 años, 42B2.2(1)
Tibia proximal no articular.Tibia proximal no articular.
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Tibia proximal no articular.Tibia proximal no articular.
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Varón 28 años hundimiento y cizallamiento lateral.
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MétodosFijación Interna
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41 B1.1 - Schatzker I
• Tornillos de tracción
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• Trazos largos
• Desplazamiento
Tornillo de tracción + placa de soporte
41 B1.1 - Schatzker I
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• Elevar el fragmento hundido
• Placa de soporte
41 B3.1 - Schatzker II
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• Elevación del hundimiento
• Control artroscopico
41 B2.1 - Schatzker III
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Hundimiento
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Artroscopia
Superfície hundida Elevación del fragmento
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Tornillos de soporte
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• Alta energia
• Evaluación vascular
• Evaluar el ciático
• Placa soporte medial
41 B1.3 - Schatzker IV
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Fijar las dos columnas
Opción: Placas con estabilidad angular
41 C1 - Schatzker V
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LCP
Tibia Proximal Lateral
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LISS
Tibia Proximal Lateral
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41 C3 - Schatzker VI
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17 dias
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17d
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9m
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En Resumen
• La clave: Respeto a los tejidos blandos
•Planificación
• Reducción anatómica de la superfície
• Restauración funcional del eje
• Fijación interna: mejores resultados
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