Percutaneous plating of periarticular tibial fractures: a reliable, reproducible technique for controlling plate passage and positioning.

This article describes percutaneous plating of periarticular tibial fractures, in which a suture, tied to the proximal pole of a precontoured plate, is used to guide the plate through a submuscular tunnel. The technique enables the surgeon to manipulate both poles of the plate during its passage and to accurately position the plate. Percutaneous techniques continue to evolve, providing the advantage of fracture fixation while preserving the integrity of the soft tissue envelope. Various clinicians have described impressive results in percutaneous fixation of fractures of the distal tibia. These techniques reduce soft tissue stripping while preserving the vascularity of the fracture site. However, because percutaneous plating can present challenges for the surgeon, meeting these challenges is essential to ensuring the reproducibility of this technique. Manipulation of both poles of the plate can be difficult, and malalignment can result if the plate is not correctly positioned. The technique described below allows the surgeon to easily manipulate both poles of the plate to achieve accurate anatomic positioning and to avoid soft tissue stripping.