Morning conference Orthopedic - Fracture of Tibial Plateau

1. Sun 15th Feb 2014
Rotate 503-504
Faculty of Medicine Siriraj hospital
Mahidol University
THailand

2. ผู้ป่วยหญิงไทย อายุ 24 ปี ไม่มีโรคประจาตัว
อาการสาคัญ ปวดเข่าขวามา 1 ชม.
1 ชม.ก่อน ขับรถมอเตอร์ไซต์ล้ม ผู้ป่วยสวมหมวกกันน๊อค
โดยรถมอเตอร์ไซต์ทับขาบริเวณหัวเข่าขวา แต่ไม่ทับบริเวณ
หน้าอก ไม่มีศีรษะล้มฟาดพื้น ไม่สลบ ลุกเดินไม่ได้ ถูกพามาส่ง
รพ.ศิริราช

3. A
B
C – V/S: T 36.8 ๐C, P96/min, RR
20/min, BP 142/104 mmHg,
O2 sat 98%
D – E4V5M6, Oriented to time, place and
person, Pupils 3 mm BRTL, No
neurological deficits
Primary Survey
No immediate life threatening

4. Extremities(Affected part):
Inspection: Swelling and deformed right leg No open wound
Palpation:
- No tenderness at right patellar
- Tenderness along lateral joint line of right knee
- Peripheral pulses at lower extremities: 2+
- No back pain
Secondary Survey

5. Extremities(Affected part):
Movement:
- Limit ROM due to pain
- Can plantar flexion and dorsiflexion (Deep peroneal nerve intact)
- No impairment of sensation
Special test:
- Ballottement +ve (Fluid collection in suprapatellar patellar pouch)

12. Problem List
1. History of Motorcycle accident
2. Split lateral plateau closed fracture of Tibia
3. Fibular head fracture with minimal displacement (Schafzker
type II)

13. Provisional Diagnosis

14. Fracture of tibia plateau
Topic Review

15. Schatzker Classification Fracture of Tibial Plateau
Type I Lateral plateau, split fracture
Type II Lateral plateau, split depression
fracture
Type III Lateral plateau, depression fracture
Type IV Medial plateau fracture
Type V Bicondylar plateau fracture
Type VI Plateau fracture with separation of
the metaphysis from the diaphysis

16. Schatzker Classification
Types I to III are low-energy injuries
Types IV to VI are high-energy injuries
Type I usually occurs in younger individuals and is associated with
medial collateral ligament injuries
Type III usually occurs in older individuals
Fracture of Tibial Plateau

17. Schatzker Classification

18. Treatment
Nonoperative
Indication:Nondisplaced or minimally displaced fracture
:Advanced osteoporosis
Fracture of Tibial Plateau

19. Treatment
Nonoperative
Protected weight bearing and early range of knee motion
Partial weight bearing (30 to 50 lb) for 8 to 12 with progression to
full weight bearing.
Fracture of Tibial Plateau

20. Treatment
Operative
Indication
Articular depression > 2 mm
Open fractures
Compartment syndrome
Associated vascular injury
Instability >10 degrees of the nearly extended knee compared to the
contralateral side
Fracture of Tibial Plateau

21. Complication
Knee stiffness
Infection
Compartment syndrome
Malunion or nonunion
Posttraumatic osteoarthritis
Peroneal nerve injury
Avascular necrosis of small articular fragments
Fracture of Tibial Plateau

23. Apply long leg slap
Advice non-weight bearing with axillary crutch
Blood for CBC, BUN, Cr, E’lyte, PT, APTT
Follow up ห้องเฝือก ตึก สยม.ชั้น 1(Feb 18th,2015)
Home medication:
Paracetamol (500 mg) 2 tabs oral pc q 4-6 hrs
Tramadol (50 mg) 1 tab oral tid pc
Leparil 2 tabs oral tid pc
Management