الفهرس 
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Abstract
the fractures involving the proximal articular surface of the tibia are grouped loosely and are defined as tibial plateau fractures (Khan et al., 2000). According to Hohl (1967), fractures of the tibial plateau make up 1% of all fractures and 8% of fractures in the elderly.
Tibial plateau fractures occur as a result of both high velocity and low velocity injuries. Fractures of the tibial plateau are usually caused by one or both of the femoral condyles impacting the articular surface of the proximal tibia under varying degrees of varus or valgus force applied across the knee. Many studies have stressed the importance of the meniscus in tibial plateau fractures. Preservation and repair of the meniscus have been advocated for meniscal injuries, which have been reported to occur in 10% to 19% of plateau fractures.
Over years, many classifications for tibial plateau fractures have been developed. All classifications are based on fracture location and degree of displacement. As stated by Schatzker et al. (1979), a classification should give information about the mechanism and the prognosis of the injury and provide guidance for treatment; it should also be simple enough for practical use. Khan et al. (2000) divided the tibial plateau fractures topographically into seven broad groups. The main benefit of using this system is to make the nomenclature easy to remember and use.
Conventional radiography remains the best, initial imaging modality to screen most of knee disorders. Meanwhile, plain radiographs clearly underestimate the extent of displacement of tibial plateau fractures. Measurement from CT scans matches that of tomograms only if the latter has been corrected for an approximate magnification of 15%. MRI provides more information that impacts on surgical planning than CT scanning.
The aim of treating tibial plateau fractures is to obtain a stable, aligned, pain-free knee with a range of motion that is satisfactory for functional outcome and to minimize the risk of post-traumatic osteoarthritis. Awareness of the factors that produce disability after tibial plateau fractures permits critical appraisal of current methods of treatment. These include limited motion, instability, angular deformity, lack of full extension, pain, traumatic arthritis, and muscular weakness.
Various methods of limited fixation of tibial plateau fractures are available. The optimal method of fixation is dictated by the degree of soft tissue injury, fracture characteristics, and functional demands of the patient. Closed reduction and percutenous fixation by cannulated screws decrease hospital stay, and decreased morbidity due to soft tissue dissection and arthrotomy. However, the technique is not without complications. Adverse outcomes have been reported that include malunion,depressed articular surface, and does not manage meniscal injury if present. Additionally, arthroscopy allows assessment and treatment of concomitant knee pathology. The procedure is technically demanding and necessitates a background of various arthroscopic skills like triangulation, proper placement of the portals, and orientation to the different anatomy in cases of a fresh intra-articular fracture. Furthermore, a potential danger of arthroscopic evaluation of tibial plateau fractures is compartment syndrome secondary to fluid extravasation.
During the period from June 2012 to June 2013, a prospective non-randomized study was undertaken to assess the value of arthroscopy in the management of selected types of proximal tibial fractures. Cases were classified according to Schatzker classification.
Closed reduction and percutenous fixation by cannulated screws is indicated in patients with a large peripheral fragment (i.e. Schatzker type-I, -II and -IV fractures). Patients with depressed fractures of >5 mm (Schatzker type-VI factures) and severe comminution should be treated with open reduction and internal fixation (using a screw-plate construct and bone grafting), as closed reduction is not feasible.
Articular reduction was rated as excellent or good in all patients reviewed in this study. No patients have ended up with a fair or poor anatomical result. Good reduction means depression ≤ 5 mm it was achieved in five cases; 2 cases of type I, 2 cases of type II and 1 case of type IV. Anatomical reduction was achieved in 10 cases; 9 cases of type I and 1 case of type IV.
At the final follow up which ranged from 6-12 months and According to Rasmussen scoring system nine patients (60%) were classified as excellent, five (33.3%) were classified as good and one (6.6%) was classified as fair.
It is obvious that, the satis¬factory results in the present study are considerably high, may be because of good selec¬tion of the patients with appro¬priate types of tibial plateau fractures to this method, also because of early mobilization of the patients.
It is concluded that the use of percutaneous reduction and fixation of tibial plateau fratures is a good meth¬od of treatment for selected types of fractures such as par¬tial articular fractures with pure split and partial articular frac-tures with split depression. Reduction and percutaneous screw fixation for tibial plateau fractures is minimally invasive. It reduces the length of hospital stay and costs, enables early mobilisation with minimal instrumentation, and achieves satisfactory outcomes.