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[1/6] Tibial plateau with eminence fracture. The Xrays show you the breaks in the plateau but also that the eminence seems odd somehow. This is more complex than it appears at first glance.
![[1/6] Tibial plateau with eminence fracture. The Xrays show you the breaks in the plateau but also that the eminence seems odd somehow. This is more complex than it appears at first glance.](https://pbs.twimg.com/media/EzgOKIhXIAIHR9S.jpg "[1/6] Tibial plateau with eminence fracture. The Xrays show you the breaks in the plateau but also that the eminence seems odd somehow. This is more complex than it appears at first glance.")
![[1/6] Tibial plateau with eminence fracture. The Xrays show you the breaks in the plateau but also that the eminence seems odd somehow. This is more complex than it appears at first glance.](https://pbs.twimg.com/media/EzgOKJHWQAIXzC7.jpg "[1/6] Tibial plateau with eminence fracture. The Xrays show you the breaks in the plateau but also that the eminence seems odd somehow. This is more complex than it appears at first glance.")
[2/6] CT gives you lots of info including comminution in the weightbearing lateral surface, and also the eminence fracture (arrow). Because of how medial this was, I planned for a femoral distractor. Make sure to limit your distraction time due to risk to peroneal nerve.
![[2/6] CT gives you lots of info including comminution in the weightbearing lateral surface, and also the eminence fracture (arrow). Because of how medial this was, I planned for a femoral distractor. Make sure to limit your distraction time due to risk to peroneal nerve.](https://pbs.twimg.com/media/EzgOK_oXEAACIOT.jpg "[2/6] CT gives you lots of info including comminution in the weightbearing lateral surface, and also the eminence fracture (arrow). Because of how medial this was, I planned for a femoral distractor. Make sure to limit your distraction time due to risk to peroneal nerve.")
![[2/6] CT gives you lots of info including comminution in the weightbearing lateral surface, and also the eminence fracture (arrow). Because of how medial this was, I planned for a femoral distractor. Make sure to limit your distraction time due to risk to peroneal nerve.](https://pbs.twimg.com/media/EzgOK_nXoAA3Qlp.jpg "[2/6] CT gives you lots of info including comminution in the weightbearing lateral surface, and also the eminence fracture (arrow). Because of how medial this was, I planned for a femoral distractor. Make sure to limit your distraction time due to risk to peroneal nerve.")
![[2/6] CT gives you lots of info including comminution in the weightbearing lateral surface, and also the eminence fracture (arrow). Because of how medial this was, I planned for a femoral distractor. Make sure to limit your distraction time due to risk to peroneal nerve.](https://pbs.twimg.com/media/EzgOLAPXsAADD6b.jpg "[2/6] CT gives you lots of info including comminution in the weightbearing lateral surface, and also the eminence fracture (arrow). Because of how medial this was, I planned for a femoral distractor. Make sure to limit your distraction time due to risk to peroneal nerve.")
![[2/6] CT gives you lots of info including comminution in the weightbearing lateral surface, and also the eminence fracture (arrow). Because of how medial this was, I planned for a femoral distractor. Make sure to limit your distraction time due to risk to peroneal nerve.](https://pbs.twimg.com/media/EzgOLBTXIAA244-.jpg "[2/6] CT gives you lots of info including comminution in the weightbearing lateral surface, and also the eminence fracture (arrow). Because of how medial this was, I planned for a femoral distractor. Make sure to limit your distraction time due to risk to peroneal nerve.")
[3/6] Once joint was distracted, I could see the eminence and maneuver it enough to k wire it to a reasonable reduction. I then brought the wire out the medial side and withdrew it so it sat flush to the eminence. Then I began lateral side reconstruction.
![[3/6] Once joint was distracted, I could see the eminence and maneuver it enough to k wire it to a reasonable reduction. I then brought the wire out the medial side and withdrew it so it sat flush to the eminence. Then I began lateral side reconstruction.](https://pbs.twimg.com/media/EzgOLqPX0AI_sPI.jpg "[3/6] Once joint was distracted, I could see the eminence and maneuver it enough to k wire it to a reasonable reduction. I then brought the wire out the medial side and withdrew it so it sat flush to the eminence. Then I began lateral side reconstruction.")
![[3/6] Once joint was distracted, I could see the eminence and maneuver it enough to k wire it to a reasonable reduction. I then brought the wire out the medial side and withdrew it so it sat flush to the eminence. Then I began lateral side reconstruction.](https://pbs.twimg.com/media/EzgOLqmXMAAlO7s.jpg "[3/6] Once joint was distracted, I could see the eminence and maneuver it enough to k wire it to a reasonable reduction. I then brought the wire out the medial side and withdrew it so it sat flush to the eminence. Then I began lateral side reconstruction.")
[4/6] Like most of my complex plateaus this one ended up a “porcupine” of K wires. Once I brought the lateral side up, I backfilled with allograft in metaphysis. To compress everything I used a periarticular clamp, withdrawing and changing wires if reduction kicked out.
![[4/6] Like most of my complex plateaus this one ended up a “porcupine” of K wires. Once I brought the lateral side up, I backfilled with allograft in metaphysis. To compress everything I used a periarticular clamp, withdrawing and changing wires if reduction kicked out.](https://pbs.twimg.com/media/EzgOMRkWEAcPQir.jpg "[4/6] Like most of my complex plateaus this one ended up a “porcupine” of K wires. Once I brought the lateral side up, I backfilled with allograft in metaphysis. To compress everything I used a periarticular clamp, withdrawing and changing wires if reduction kicked out.")
![[4/6] Like most of my complex plateaus this one ended up a “porcupine” of K wires. Once I brought the lateral side up, I backfilled with allograft in metaphysis. To compress everything I used a periarticular clamp, withdrawing and changing wires if reduction kicked out.](https://pbs.twimg.com/media/EzgOMRlX0AYP0JI.jpg "[4/6] Like most of my complex plateaus this one ended up a “porcupine” of K wires. Once I brought the lateral side up, I backfilled with allograft in metaphysis. To compress everything I used a periarticular clamp, withdrawing and changing wires if reduction kicked out.")
![[4/6] Like most of my complex plateaus this one ended up a “porcupine” of K wires. Once I brought the lateral side up, I backfilled with allograft in metaphysis. To compress everything I used a periarticular clamp, withdrawing and changing wires if reduction kicked out.](https://pbs.twimg.com/media/EzgOMUMXEAIXHu-.jpg "[4/6] Like most of my complex plateaus this one ended up a “porcupine” of K wires. Once I brought the lateral side up, I backfilled with allograft in metaphysis. To compress everything I used a periarticular clamp, withdrawing and changing wires if reduction kicked out.")
[5/6] This plate has small screws in proximal row, and I placed it more distally than usual so I could angle the little screws toward the eminence as best I could, without entering the joint. These screws also rafted the articular surface. The distractor was off at this point.
![[5/6] This plate has small screws in proximal row, and I placed it more distally than usual so I could angle the little screws toward the eminence as best I could, without entering the joint. These screws also rafted the articular surface. The distractor was off at this point.](https://pbs.twimg.com/media/EzgOM6ZXMAIHHiS.jpg "[5/6] This plate has small screws in proximal row, and I placed it more distally than usual so I could angle the little screws toward the eminence as best I could, without entering the joint. These screws also rafted the articular surface. The distractor was off at this point.")
![[5/6] This plate has small screws in proximal row, and I placed it more distally than usual so I could angle the little screws toward the eminence as best I could, without entering the joint. These screws also rafted the articular surface. The distractor was off at this point.](https://pbs.twimg.com/media/EzgOM76WEAAAS9_.jpg "[5/6] This plate has small screws in proximal row, and I placed it more distally than usual so I could angle the little screws toward the eminence as best I could, without entering the joint. These screws also rafted the articular surface. The distractor was off at this point.")
![[5/6] This plate has small screws in proximal row, and I placed it more distally than usual so I could angle the little screws toward the eminence as best I could, without entering the joint. These screws also rafted the articular surface. The distractor was off at this point.](https://pbs.twimg.com/media/EzgOM-OXoAgpec_.jpg "[5/6] This plate has small screws in proximal row, and I placed it more distally than usual so I could angle the little screws toward the eminence as best I could, without entering the joint. These screws also rafted the articular surface. The distractor was off at this point.")
![[5/6] This plate has small screws in proximal row, and I placed it more distally than usual so I could angle the little screws toward the eminence as best I could, without entering the joint. These screws also rafted the articular surface. The distractor was off at this point.](https://pbs.twimg.com/media/EzgONAoWEAMLu4X.jpg "[5/6] This plate has small screws in proximal row, and I placed it more distally than usual so I could angle the little screws toward the eminence as best I could, without entering the joint. These screws also rafted the articular surface. The distractor was off at this point.")
[6/6] The finals show the two little screws entering the eminence piece on the lateral. A screw proximal to distal like in a pediatric eminence case would also have been an option, but this was stable. Other than plate sitting a little off because it’s distal, looks fine.
![[6/6] The finals show the two little screws entering the eminence piece on the lateral. A screw proximal to distal like in a pediatric eminence case would also have been an option, but this was stable. Other than plate sitting a little off because it’s distal, looks fine.](https://pbs.twimg.com/media/EzgONcHWYAATA81.jpg "[6/6] The finals show the two little screws entering the eminence piece on the lateral. A screw proximal to distal like in a pediatric eminence case would also have been an option, but this was stable. Other than plate sitting a little off because it’s distal, looks fine.")
![[6/6] The finals show the two little screws entering the eminence piece on the lateral. A screw proximal to distal like in a pediatric eminence case would also have been an option, but this was stable. Other than plate sitting a little off because it’s distal, looks fine.](https://pbs.twimg.com/media/EzgONduXMAY5T8K.jpg "[6/6] The finals show the two little screws entering the eminence piece on the lateral. A screw proximal to distal like in a pediatric eminence case would also have been an option, but this was stable. Other than plate sitting a little off because it’s distal, looks fine.")
