Tibial Plateau Fracture mechanism
- varus/valgus load ± axial loading (e.g. fall from height)
- femoral condyles driven into proximal tibia
- can result from minor trauma in those with osteoporosis
Tibial Plateau Fracture clinical features
- frequency: lateral > bicondylar > medial
- medial fractures require higher energy – often have concomitant vascular injuries
- knee effusion
- inability to bear weight
- swelling
- associated with compartment syndrome, ACL injury, and meniscal tears
- Schatzker classification
Tibial Plateau Fracture investigations
- X-ray: AP, lateral, oblique
- CT: pre-operative planning, identify articular depression and comminution
- ABI if any differences in pulses between extremities
Tibial Plateau Fracture treatment
Approach #1 - (based on amount of depression seen on x-ray)
Non-operative indication (if depression on x-ray is <3 mm): straight leg immobilization x 4-6 wk with progressive ROM weight bearing
Operative indication (if depression is >3 mm): ORIF often requiring bone grafting to elevate depressed fragment
Approach #2 (based on varus/ valgus instability) Non-operative indication (if minimal varus/valgus instability [<15°]): straight leg immobilization x 4-6 wk with progressive ROM weight bearing Operative indication (if significant varus/valgus instability [>15°]): ORIF often requiring bone grafting to elevate depressed fragment
Tibial Plateau Fracture specific complications
- ligamentous injuries
- meniscal lesions
- AVN
- infection
- OA
Schatzker Classification
Type I - Involvement of lateral plateau split fracture
II Lateral split-depressed fracture
III Involvement of lateral plateau: pure depression fracture
IV Medial plateau fracture
V Bicondylar plateau fracture
VI Bicondylar with metaphyseal/diaphyseal involvement
Most common long bone fracture and open fracture
Tibial shaft fracture
Tibial shaft fracture mechanism
- low energy pattern: torsional injury
* high energy: including MVC, falls, sporting injuries
Tibial shaft fracture clinical features
- pain, inability to weight bear
- open vs. closed
- neurovascular compromise
Tibial shaft fracture investigations
• X-ray: AP lateral
■ full length, plus knee and ankle
Tibial shaft fracture treatment
• non-operative
■ indication closed and minimally displaced or adequate closed reduction
◆ long leg cast x 8-12 wk, functional brace after
• operative
■ indication: displaced or open
◆ if displaced and closed: ORIF with IM nail, plate and screws, or external fixator
◆ if open: antibiotics, I&D, external fixation or IM nail, and vascularized coverage of soft tissue defects
Tibial shaft fracture specific complications
- high incidence of neurovascular injury and compartment syndrome
- poor soft tissue coverage (critical to outcome)
Tibial shaft fractures have high incidence of compartment syndrome and are often associated with soft tissue injuries
Difference between scapular Y and lateral view
same thing
