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37 Cards in this Set
- Front
- Back
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most common fracture pattern from simple fall
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lateral split depression
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incidence of associated collateral ligament injury in tibial plateau fractures
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3% each for both MCL and LCL
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pathognomonic injuries for cruciate ligament injury
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segond fracture
reverse segond fracture anteromedial tibial margin fractures semimembranosus tendon insertion site fractures |
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split lateral plateau fractures typically result from...
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low-energy forces from falls and twisting injuries
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rate of compartment syndrome in all tibial plateau fractures
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10%
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risk of compartment syndrome in Schatzker 6 fractures
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30%
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eventual alignment of the knee after fracture healing is determined by...
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extra-articular fracture deformity
residual articular depression knee instability |
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important features of soft tissues
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severity of swelling
visible contusions fracture blisters (location, character, size) |
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xrays
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AP
lateral AP view of plateau (10-15 degree caudal view) traction obliques |
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descriptive classification
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location
medial/lateral condyle involvement split, split depression, local compression, bicondylar displacement angulation comminution presence of subluxation or dislocation amount of articular surface depression |
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advantages of AO/OTA classification
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identifies both articular and nonarticular fractures
distinguishes proximal tibia from tibial shaft fractures distinguishes ranges of severity in high-energy patterns |
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rule of squares
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identifies a proximal tibial fracture as one where the center of the fracture is within a square with one side along the articular surface and the length of a defined by the width of the metaphyseal segment
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AO/OTA classification of proximal tibial fractures
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A: extra-articular
1: avulsion (fibula, tibial tuberosity, cruciate insertion) 2: simple (obl frontal, obl sag, transverse) 3: multifrag (intact wedge, frag wedge, complex) B: simple articular 1: split (lateral, medial, oblique) 2: depression (lat total, lat limited, medial) 3: split depression (lateral, medial, oblique) C: complete articular 1: simple, simple 2: simple, multifrag metaphysis (intact wedge, frag wedge, complex) 3: articular multifrag (lateral, medial, bilateral) |
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Schatzker classification
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1: lateral split or cleavage fracture
2: lateral split or cleavage depression 3: lateral local compression or pure central depression 4: medial condyle fractures 5: bicondylar fracture 6: shaft dissociated from metaphysis |
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associated injuries with type 4
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compartment syndrome
peroneal nerve injury vascular injury (worse as fracture line moves laterally) |
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high incidence of associated ACL injury with?
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posteromedial fracture patterns
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weakness of Schatzker classification
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wide range of patterns requiring different management strategies that all fit in Schatzker 6 category
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fibular head attachments
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LCL
biceps femoris tendon |
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IT band insertion
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Gerdy's tubercle
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lateral tibial plateau characteristics
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flat or slightly convex
higher than medial side |
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medial tibial plateau characteristics
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concave
lower than lateral side |
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sagittal slope
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0-14 degrees laterally
-3 to +10 degrees medially |
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coronal slope
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-1 to +6 degrees
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cartilage of tibial plateau
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covered by hyaline
fibrocartilaginous menisci coronary ligaments (meniscotibial ligaments) |
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which plateau has greater meniscal coverage
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lateral
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separation of medial and lateral plateau
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intercondylar eminence and medial and lateral tibial spines
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occults injury to anterior tibial artery may account for...
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compartment syndrome
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isolated lateral plateau fractures
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55-70%
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percent open fractures
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1-3%
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normal posteroinferior slope
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10 degrees
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why is fracture of lateral plateau more common?
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medial articular surgace and supportin gmedial condyle are stronger than lateral counterparts
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where trifurcation of popliteal artery is tethered
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between adductor hiatus proximally and soleus complex distally
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meniscal injury associated with plateau fractures
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50%
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Segond sign
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lateral capsular avulsion
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Pellegrini-STeata lesion
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calcification along the insertion of the MCL
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signs of associated ligamentous injury
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fibular head avulsion
segond pellegrini-steata |
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surgical indications
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articular depression >2 mm to 1 cm
instability >10 degrees of nearly extended knee compared to contralateral open compartment syndrome associated vascular injury |
