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Dr. Ebraheim’s educational animated video describes intra-articular extensile approach to tibial plateau fractures with tear of the meniscus. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Severe types of tibial plateau fractures are a complex management problem. The knee joint may have a significant comminuation and depression, and the physician may need extensile approach for reduction and fixation of this fracture. I use the intra-articular extensile approach for tibial plateau fracture reduction and fixation. In general, fracture of the tibial plateau is a complicated problem. The ankle-brachial index (ABI) is needed in some types such as in medial plateau fractures or in severe types such as Schatzaker type V or type VI. In general, medial tibial plateau fractures are considered to be a knee dislocation. You may also need to do fasciotomy for compartment syndrome. The soft tissue condition may be bad. You may want to use and external fixator initially until the soft tissue condition improves. The associate between tibial plateau fractures and meniscal tear is not uncommon. The lateral plateau fracture will give lateral meniscal tear. The medial plateau fracture will give medial meniscal tear. Tear of the meniscus is usually peripheral it should be recognized and dealt with. You may want to look at the x-ray and see if you have depression or separation more than 6 mm (high chance of meniscal tear). The posteromedial fragment is another problem with tibial plateau fractures which needs to be fixed separately. When we have extensive comminuted displaced tibial plateau fracture, you may need excellent exposure of the articular surface to allow for anatomic reduction of the joint and visualization and repair or debridement of the meniscus if it is torn. This extensile exposure is important especially if the posterior part of the plateau is also involved. The traditional way to see the articular cartilage of the tibial plateau is to do submeniscal approach by cutting the coronary ligament, but the exposure is limited. Other extensile approaches are also developed, however we use the extensile intra-articular approach for complex, comminuted tibial plateau fractures. It involves anterior detachment and retraction of the meniscus to improve visualization of the tibial articular surface. This approach can be utilized for lateral or medial tibial plateau fractures and it is especially helpful in diagnosing and repairing the torn meniscus. It allows inspection of the meniscus pathology in fractures of the articular surface. It improves reduction of the fracture and the torn meniscus is repaired and reattached to the coronary ligament. Incision and reflection of the meniscus allows great exposure and inspection of the joint which is followed by reattachment and suturing of the anterior horn of the meniscus to its normal position which is followed by reattachment of the meniscotibial (coronary) ligament. The sutures are tied to the side of the patellar tendon on the opposite side of the meniscus.