Fig. 3.

A 45-year-old male fell 15 feet off a ladder and sustained a left-sided Shatzker II type tibial plateau fracture. He was taken to a local hospital and open reduction and internal fixation (ORIF) was performed with placement of a locking plate. He followed-up with his treating surgeon and was referred to our institution at seven months for treatment of an intraarticular tibial plateau nonunion. A CT scan was performed for confirmation of the nonunion and further delineation of the depressed fragment in the lateral plateau. Revision ORIF was performed with complete hardware removal, intraarticular osteotomy and elevation of the depressed fragment, placement of DBM bone graft, placement of a proximal tibia locking plate and screws including interfragmentary lag screws, and repair of a lateral meniscus tear. He returned at regular follow-up intervals and at his latest follow-up at six months he presented with good radiographic and clinical results including a healed tibial plateau nonunion, a significant improvement in pain, and a return to his pre-injury activities. His radiographs demonstrate evidence of moderate osteoarthritis (OA) in his lateral joint space which does not limit him from his activities and he has resumed his hobbies of horse riding and competition in polo matches. Anteroposterior (AP) (a) and lateral (b) radiographs and CT scan images seven months following ORIF for a right-sided Shatzker II type tibial plateau fracture illustrating a nonunion with presence of a depressed fracture fragment. c Preoperative plan for revision surgery. d Intraoperative fluoroscopic AP and lateral images. e AP and lateral images at six months following revision surgery revealing a healed tibial plateau nonunion and evidence of moderate OA in the lateral joint space