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Elevation of depressed articular fragments is crucial for anatomic reduction of tibial plateau fractures. We describe a technique of elevating the depressed fragment using a cortical window, an external fixator connecting rod (Fig 1) and injectable bone substitute.Figure 1External fixator rodA cortical window is made under image guidance using a 2.5mm drill to make four holes in a square configuration. A narrow osteotome is used to connect three sides. The connecting rod is inserted into the cortical window and used as a punch to elevate the articular fragment under image guidance (Fig 2). Injectable bone substitute is then used to fill the defect created (Fig 3).Figure 2Elevation of articular fragment with the connecting rodFigure 3Injectable bone substitute used to fill defect

annals of the royal college of surgeons of england

The novel use of an external fixator connecting rod and synthetic bone substitute to achieve anatomic reduction of depressed tibial plateau fracture fragments