**3. Diagnostic**

The clinical diagnostic is sustained by the following clinical signs:


The Role of Arthroscopy in Mini-Invasive Treatment of Tibial Plateau Fractures 227

Using the reconstruction in sagital and coronal plane of the images more information about the type and localization of the fracture is obtained (Rafii et al., 1987). CT exam is mandatory for the surgical treatment planning in type IV, V and VI Schatzer. By all experience of using CT and Xray exams, after several different cases, the surgeon will understand the fracture

Most surgeons use different kind of plates with screws with open reduction of the fracture:

The minimal invasive surgical treatment of these kind of fractures should be done under

This technique is particularly adapted to each Schatzker type, inspite of others (Casteleyn & Handelberg, 2001) considering a limited role of arthroscopy only in relative simple split,

The patient is under spinal anesthesia, then the fragments of the fracture are identified using Xray control. The reduction of the fracture is then atempted by flexion, extension, traction

Standard arthroscopic portals can be used, joint irrigation is mandatory with a low pressure gravity feed, and a tourniquet is always necessary to reduce bleeding. Some arthrocopic surgical experience is necessary. The scope must be left for a few seconds in the same position in order to flush the blood and visualise the lessions. Prolonged operation time may lead to increased fluid effusion with compartimental syndrome or deep venous thrombosis.

In case of fractures with pure cleavage, split fractures, K wires are inserted rectangularly on the fracture's line, subchondral, under Xray and arthroscopic guidance. Eventually compression forces are applied by putting cannulated cancellous screws in paralel planes. In case of fractures with depression, a K wire is inserted in the depressed bone fragment. Then this bone fragment is lifted under Xray and arthroscopic control and then another K wire is inserted through these reduced bone fragments, subchondral. Eventually

In case of combinated fractures, cleavage and depression a K wire is inserted through the fracture's cleavage directly in the depressed bone fragment, and this depressed bone fragment is lifted using strong forces till the K wire is bend, under Xray and arthroscopic control. Then another K wire is inserted through these reduced bone fragments, perpendiculary to the cleavage fracture, then compression forces are applied by putting paralel cancellous screws. After the alignment of the articular surface is obtained these fragments are fixed with cancellous screws or another K wire. In case of cominuted fractures, first the depression is reduced and then the cleavage. The forces applied on the K

In case of Schatzker type V-VI external fixation is used after obtaining the alignment of the

The technique will be described particularly adapted to each Schatzker type.

compression forces are applied by putting cancellous screws in paralel planes.

wire for the alignment of the fracture are very strong ( Cristea et al., 2010).

**3.2 CT diagnostic** 

aspect only by Xray exams.

**4. Surgical treatment** 


fluoroscopic and arthroscopic control.

depression and split-depression fracures.

(ligamentotaxis) (Sirkin et al., 2000).

articular surface ( Cristea et al., 2010).


Fig. 1. Schatzker's Classification
