Preoperative planning of proximal tibial fractures

Historically open reduction and internal !xation of high energy proximal tibia fractures have been associated with high rates of infection (13–88%) and nowadays staged protocol for management was proposed (1). Also articular step o"s and angular deformities after operative treatment are observed in 10–19% of cases (2). Taking all this into account the complex tibial plateau fractures management remains very challenging for any orthopaedic or trauma surgeon. Traditionally the understanding of these fractures was based on two-dimensional classi!cation systems (3), but CT based three-dimensional consideration of the fracture pattern is very important in the decision making regarding treatment. Luo (3) made a three column !xation concept based on 3D imaging of the fracture. Also other authors described new approaches especially the need for posterior one (2,3). With analogy to acetabular fractures it is impossible to present the whole tibial plateau with one surgical approach. Because of injured soft tissue envelope the separate surgical approaches should be carefully planned. Surgical !xation should take into consideration the biomechanics of the fracture (buttressing on the right site for example). So we assumed that accurate preoperative planning is of utmost importance in these di#cult injuries. Using the staged protocol, the surgeon has some extra time which can be used for preoperative planning. We used EBS software for preoperative planning of high energy tibial plateau fractures. Material and methods