ORTHOPAEDICS - ADULT
TIBIAL PLATEAU
PromptShatzker grading system
ResponseLet me tell you a story
I - I had a friend, he lived on the outside of town (lateral). He SPLIT with his girlfriend (lateral split)
II - After a while, he was split and got depressed (Split + depression #)
III - it had been so long he was now just depressed (Depression #)
IV - he was over women, he decided to go to the other side (Medial #)
V - he realised he liked it both ways (Medial and lateral #)
VI - and then things just got fucked up (XR is fucked up bad)
Dr. D (now an ortho BOSS!)
I - I had a friend, he lived on the outside of town (lateral). He SPLIT with his girlfriend (lateral split)
II - After a while, he was split and got depressed (Split + depression #)
III - it had been so long he was now just depressed (Depression #)
IV - he was over women, he decided to go to the other side (Medial #)
V - he realised he liked it both ways (Medial and lateral #)
VI - and then things just got fucked up (XR is fucked up bad)
Dr. D (now an ortho BOSS!)
Prompt
Response
Lipohaemarthrosis
Lateral tibial plateau fracture - Shatzkaer I or II (R knee)
Lipohaemarthrosis
Lateral tibial plateau fracture - Shatzkaer I or II (R knee)
Prompt
Response
Comminuted fracture medial tibial plateau, depressed = Shatzker IV
Intercondylar extension
Posterior displacement of medial tibial plateau
Subluxation of knee joint with anteriolateral translocation of tibia relative to femur
Lipohemarthrosis
Mgmt - knee joint relocation + splint, CT angio of popliteal artery once relocated
Comminuted fracture medial tibial plateau, depressed = Shatzker IV
Intercondylar extension
Posterior displacement of medial tibial plateau
Subluxation of knee joint with anteriolateral translocation of tibia relative to femur
Lipohemarthrosis
Mgmt - knee joint relocation + splint, CT angio of popliteal artery once relocated
Prompt
ResponseTibial plateau fracture, comminuted
Both lateral and medial condiles involved, Lateral displacement of knee
Head of fibular comminuted fracture
= Shatzker 6 tibial plateau fracture
Soft tissue swelling in calf
Both lateral and medial condiles involved, Lateral displacement of knee
Head of fibular comminuted fracture
= Shatzker 6 tibial plateau fracture
Soft tissue swelling in calf
Prompt
ResponseGrossly swollen shin/calf concerning for compartment syndrome
Dusky discolouration of foot
Grossly swollen knee ? haemathrosis
Bruising medial knee and ankle
Dusky discolouration of foot
Grossly swollen knee ? haemathrosis
Bruising medial knee and ankle
PromptAssociated injuries in tibial plateau fractures
ResponseLigamentous/MSK (non neurovascular)
MCL
ACL
Patellar tendon - loss of extensor mechanism
Lateral meniscus - locking knee joint
Hamstring tendon - Pain posterior to thigh
Neurologic
Common peroneal nerve - loss of eversion/dorsiflexion
Posterior tibial nerve injury - loss of plantarflexion, loss of sole in foot
Vascular
Popliteal artery dissection- Decreased perfusion/pulses in lower legs
Compartment syndrome - extreme pain, loss of neurovascular function, tense compartment
Surgical/Fracture related
non union/malunion
Surgical complications (Infection, pain, etc)
MCL
ACL
Patellar tendon - loss of extensor mechanism
Lateral meniscus - locking knee joint
Hamstring tendon - Pain posterior to thigh
Neurologic
Common peroneal nerve - loss of eversion/dorsiflexion
Posterior tibial nerve injury - loss of plantarflexion, loss of sole in foot
Vascular
Popliteal artery dissection- Decreased perfusion/pulses in lower legs
Compartment syndrome - extreme pain, loss of neurovascular function, tense compartment
Surgical/Fracture related
non union/malunion
Surgical complications (Infection, pain, etc)
PromptManagement of tibial plateau fracture - Conservative
ResponseMinimally displaced + stable fractures = Conservative management
Hinged knee brace, NWB
Analgesia
Orthopaedic follow up
Hinged knee brace, NWB
Analgesia
Orthopaedic follow up
PromptManagement of tibial plateau fracture - Operative
ResponseImmobilise in above knee backslab in position of comfort
Assessment of compartment pressures/compartment syndrome - Fasciotomy if pressures >30
Referral to orthopaedics for ORIF
Assessment of compartment pressures/compartment syndrome - Fasciotomy if pressures >30
Referral to orthopaedics for ORIF
- Significant articular step-off (5-10 mm)
- condylar widening,
- ligamentous instability
- Schatzer IV, V, and VI injuries