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Difference between revisions of "Tibial plateau fracture"
From WikEM
(→Imaging) |
(→Disposition) |
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| Line 37: | Line 37: | ||
**Significant displacement or depression | **Significant displacement or depression | ||
**Suspected or documented ligamentous injury | **Suspected or documented ligamentous injury | ||
| + | *Indications for surgery | ||
| + | **articular stepoff > 3mm | ||
| + | **condylar widening > 5mm | ||
| + | **varus/valgus instability | ||
| + | **all medial plateau fxs | ||
| + | **all bicondylar fxs | ||
==See Also== | ==See Also== | ||
Revision as of 16:16, 9 May 2017
Contents
Background
- ACL and MCL injuries associated with lateral plateau fracture
- PCL and LCL associated with medial plateau fracture
- Compartment syndrome may occur
- Segond Fracture
- Avulsion fracture of margin of lateral tibial plateau just below joint line
- Associated with tear of ACL and meniscal ligaments
Clinical Features
- Occurs via axial load that drives femoral condyle into tibia
Differential Diagnosis
Knee diagnoses
Acute Injury
- Knee fractures
- Patella fracture
- Tibial plateau fracture
- Knee dislocation
- Patella dislocation
- Segond fracture
- Meniscus and ligament knee injuries
- Patellar Tendinitis (Jumper's knee)
- Patellar tendon rupture
- Quadriceps tendon rupture
Nontraumatic/Subacute
- Septic Joint
- Gout
- Popliteal cyst (Baker's)
- Prepatellar bursitis (nonseptic)
- Septic bursitis
- Pes anserine bursitis
- Patellofemoral syndrome (Runner's Knee)
- Patellar Tendinitis (Jumper's knee)
- Osgood-Schlatter disease
- Arthritis
Distal Leg Fractures
- Tibial plateau fracture
- Tibial shaft fracture
- Pilon fracture
- Maisonneuve fracture
- Tibia fracture (peds)
- Ankle fracture
- Foot and toe fractures
Evaluation
Imaging
- AP, lateral, oblique views (internal for lateral plateau, external for medial plateau). Tunnel view may also be helpful.
- AP - line drawn at lateral margin of femur should not have >5mm of tibia beyond it
- CT or MRI should be considered if plain film negative but high clinical suspicion based on mechanism or inability to bear weight
Schatzker Classification
- Schatzker I Lateral split
- Schatzker II Split with depression
- Schatzker III Pure lateral depression
- Schatzker IV Pure medial depression
- Schatzker V Bicondylar
- Schatzker VI Split extends to metadiaphysis
Management
- Knee immobilizer with non-weightbearing and ortho referral in 2-7d
Disposition
- Indications for referral within 48hr:
- Significant displacement or depression
- Suspected or documented ligamentous injury
- Indications for surgery
- articular stepoff > 3mm
- condylar widening > 5mm
- varus/valgus instability
- all medial plateau fxs
- all bicondylar fxs
See Also
References
Authors
Ross Donaldson, Jay, Michael Holtz, Daniel Ostermayer, Neil Young
