• Dian-Qing Li, De-Ye Song, Jiang-Dong Ni, Mu-Liang Ding, and Jun Huang.
• Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
• Medicine (Baltimore). 2017 Nov 1; 96 (45): e8394.

RationaleThe knee joint is an important weight-bearing joint, tibial plateau fractures affect knee function and stability. High-energy intra-articular fractures involving the tibial plateau can cause management-related problems such as wound dehiscence; severe comminution leading to malalignment; and delayed complications such as varus collapse, implant failure, and arthritis of the knee joint. The treatment of severe or complex tibial plateau fractures can be quite difficult. Traditional methods of open reduction and plating require extensive exposures, which may further compromise soft tissue and devascularize bone fragments, leading to infection. In this case, a novel device, double reverse traction combined with MIPPO technique, was used and provided the possibility of minimally invasive and personalized orthopedic surgery to treat severe comminuted Schatzker type VI tibial plateau fracture and tibial shaft fracture and got satisfactory results.Patient ConcernsA previously healthy 56-year-old man presented to the emergency room after a fall from a height, who lost the movement of the left knee with pain and swelling.DiagnosesX-rays showed a tibial plateau comminuted fracture, Schatzker type VI, and tibial shaft fracture.InterventionsApplying less extensile exposure and the indirect reduction technique of double reverse traction and closed reduction combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique, we got satisfactory recovery of the severe comminuted Schatzker type VI tibial plateau fracture and tibial shaft fracture.OutcomesThis severe comminuted fracture and tibial shaft fracture were successfully reduced and got satisfactory recovery of knee joint function.LessonsDouble reverse traction combined with MIPPO technique can reduce the risk of surgical complications, such as bleeding, oozing, and wound infection. It can be applied in patients with comorbidities such as cardiac disease, hypertension, and heart failure who may otherwise not be candidates for surgery. The cost burden is lower than that of the traditional traction table.

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