1/2/2024 0 Comments Occult tibial plateau fractureThe width and depth of the depression will determine treatment. O Type III. This is a lateral split with depression. This generally happens in patients with osteoporosis. O Type II. This is a pure depression fracture. O Type I. This is a lateral split fracture. Consultation and Classification The Schatzker classification: Patients with Type IV-VI fractures may require admission for pain control and monitoring. They need to follow-up with the orthopedic surgeon in 5-7 days. Patients with a tibial plateau fracture that will require operative management may be discharged from the ER. You need to make sure they don’t have compartment syndrome or neurovascular injury. Should the patient sleep in the knee immobilizer? Yes, for the first few weeks. Range of motion exercises should start within 1-2 weeks. Passive range of motion with physical therapy followed by active range of motion and on to a graduated weight bearing protocol at 6-8 weeks. Patients should be evaluated by an orthopedic surgeon within a week. Patients can be placed in a knee immobilizer in the ED. They will need to transition to a knee brace with a hinge as soon as possible. How should you treat patients who will be managed non-operatively? Patients should be non-weightbearing. Any neurovascular injury, compartment syndrome or open fracture needs operative repair.Įlderly patients with multiple comorbid conditions and minimal displacement may be treated nonoperatively. Schatzker categories IV, V and VI need to be treated surgically. This is associated with increased risk of meniscal injury. Who needs surgery? Depression greater than 5mm of the segment. Ramadorai views compartment syndrome as a clinical diagnosis and advises treatment if it is suspected. Should we check the compartment pressure? It depends on your consultant. They can cause long term disability due to joint degeneration. The tibial plateau is an important part of the knee joint. Tibial plateau fractures are inherently intra-articular. However, continued weight-bearing can worsen the depression. Missed diagnosis of tibial plateau fractures rarely requires significant surgical intervention. Patients with lateral tibial plateau fractures may have up to 1cm of depression but still do ok. Sometimes a lateral plateau fracture identified on plain films will have an associated medial plateau fracture identified on CT which will change management. Guidelines determine management based on the depth and width of the segment. CT scans will allow you to determine the amount of depression. This can sometimes identify medial or lateral plateau fractures without a CT scan.ĭo you need to get a CT scan? This is useful for determining operative repair. When should we suspect an occult tibial plateau fracture? If the patient has a large effusion and a mechanism consistent with a tibial plateau fracture (for example, the patient was hit from the side by a car), you can obtain oblique views with the knee internally and externally rotated about 15-20 degrees. How frequently are plain films negative? There isn’t good literature available. ❏ CT scans are useful for determining need for operative intervention. ❏ If moving the big toe up and down causes significant pain, you should be very concerned for compartment syndrome. ❏ Tibial plateau fractures from higher energy mechanisms of injury are at increased risk of compartment syndrome.
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