[Ortho] Что делать с эпифизом tibia?

[Nikolaj Wolfson]

Thanks for sharing this case.
Based on the images ( it would be nice to have axial cuts),it seems to
be posteromedial fragment, almost all the way into 
posterior portion of the tibial eminance.

Approach: posteromedial, but you have to open the joint, since the
fragment is small and there will be an issue with the 
medial meniscus ( likely torn).

The appearance of the fragment is indicative of a shearing injury, so
you will need small screws ( hand set ) that will 
have to be subchondral, or, start from the back and transfix the
fragment going into anteroinferior direction. MRI might be 
sometimes useful to assess integrity of the ligaments. I hope there is
no vascular issues. 

Good luck.

Nikolaj 

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California