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Re: Что делать с эпифизом tibia?
Nikolaj Wolfson 07 Август 2007, 05:55
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Dear Alex:
Thanks for sharing this case.
Based on the images ( it would be nice to have axial cuts),it seems to be posteromedial fragment, almost all the way into
posterior portion of the tibial eminance.
Approach: posteromedial, but you have to open the joint, since the fragment is small and there will be an issue with the
medial meniscus ( likely torn).
The appearance of the fragment is indicative of a shearing injury, so you will need small screws ( hand set ) that will
have to be subchondral, or, start from the back and transfix the fragment going into anteroinferior direction. MRI might be
sometimes useful to assess integrity of the ligaments. I hope there is no vascular issues.
Good luck.
Nikolaj
Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
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