David Seligson, MD

Bone grafting is an essential component of restoring three-dimensional osseous architecture. Surgical correction of hard tissue deficiencies presents challenges in both the functional and aesthetic realms. Autogenous bone harvested from secondary surgical sites provides great utility in reconstructing defects, augmenting healing, treating nonunions, arthrodesis and lengthening bones. While a number of options are available in allograft, autograft and bone graft substitutes, the benefits of osteogenesis and osteoinduction in autografts, as well as its mechanical and handling characteristics, make it the gold standard.

The split-depression lateral plateau fracture is a common fracture pattern. Usually, the fracture is approached laterally, the split reduced with a bone clamp, the articular depression reduced through a cortical window and the fragment maintained in place with bone graft or bone graft substitute. Actually, this sequence may make perfect reduction impossible because the space for the articular fragment is too narrow. This is the “trap door” effect. In this technique tip, we recommend reducing the depression prior to clamping the split fragment.