What's the Diagnosis? By Dr. Loran Hatch
A 55 yo M presents to the ED after being struck by a motor vehicle. He is complaining of R knee pain and is unable to walk following the accident. A R knee xray is obtained. What's the diagnosis? (scroll down for answer) .
Answer: Tibial Plateau Fracture (also note proximal fibular fracture)
- Major weight bearing joint
- Mechanism of injury is usally high energy trauma
- Fall from height
- Auto vs pedestrian- proximal tibia struck by car bumper
- Axial compression w/ rotation or valgus/varus stress
- Schatzker classification: Type I-VI in regards to medial, lateral vs. bicondylar and varying degrees of depression
- Associated w ligamentous or meniscal injuries, vascular injuries, compartment syndrome
- Treatment: early ortho consult, long leg posterior splint, crutches, NWB
- Surgical indications: open fracture, compartment syndrome, vascular injury, lateral plateau w/ step off > 3mm, condylar widening > 5mm, displaced medial plateau, bicondylar fracture
Mthethaw J, Chikate A.. A review of the management of tibial plateau fractures. Musculoskeletal Surgery (2018) 102: 119-127. DOI:10.1007/s12306-017-0514-8
Bond, Michael C.. Knee. Simon’s Emergency Orthopedics, 7e Ed. Scott C. Sherman. New York, NY: McGraw-Hill, 2014.