Knee Trauma - Tibial Plateau Fractures
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Questions and Answers

What is the classification of tibial plateau fractures?

  • Schatzker classification (correct)
  • Tehranzadeh classification
  • Hohl and Moore Classification
  • Pauwels classification

What alternative classification may be used for tibial plateau fractures?

  • Evans classification
  • OTA/AO classification
  • Hohl and Moore Classification (correct)
  • Garden classification

What are the associated injuries for types I and III tibial plateau fractures?

Types I to III are low-energy injuries.

What intra-articular injury commonly occurs with a Schatzker Type 2 tibial plateau fracture?

<p>Lateral meniscus tear</p> Signup and view all the answers

Which Schatzker classification is referred to as a 'knee dislocation' equivalent?

<p>Type 4</p> Signup and view all the answers

With Schatzker type 4 tibial plateau fracture, which structure should be examined for injury?

<p>Popliteal artery</p> Signup and view all the answers

If a difference in palpable pulse strength is noted, what test should be performed?

<p>Ankle brachial index (ABI)</p> Signup and view all the answers

Which types of tibial plateau fractures have a high association with compartment syndrome?

<p>Schatzker Type 4 and Type 6</p> Signup and view all the answers

What are the operative indications for a tibial plateau fracture?

<p>Articular step-off &gt; 3mm, condylar widening &gt; 5mm, all bicondylar and medial plateau fractures, open fractures, varus/valgus instability</p> Signup and view all the answers

In a tibial plateau fracture requiring external fixation, when should a CT scan be performed?

<p>After fixator application</p> Signup and view all the answers

During ORIF, what is commonly used to fill a metaphyseal void?

<p>Calcium phosphate</p> Signup and view all the answers

What substitute has a high rate of subsidence and drainage if used to fill a metaphyseal void?

<p>Calcium sulfate</p> Signup and view all the answers

What factors are critical to restore following ORIF of tibial plateau fractures?

<p>Length, mechanical alignment, rotation</p> Signup and view all the answers

What is the most common complication following tibial plateau fractures?

<p>Post-traumatic arthritis</p> Signup and view all the answers

Flashcards

Schatzker Classification

A classification system for tibial plateau fractures based on the location and nature of the fracture. It categorizes fractures into six types: lateral split, lateral split with depression, lateral depression only, medial split, bicondylar, and metaphyseal-diaphyseal dissociation.

Hohl and Moore Classification

A classification system that groups tibial plateau fractures into five types: coronal split, entire condyle, lateral plateau rim avulsion, rim compression, and four-part fractures.

Schatzker Type 1 Fracture

Tibial plateau fractures involving a split in the lateral side of the plateau, without any depression.

Schatzker Type 2 Fracture

Features a lateral split with bony depression, where the fractured bone segment is pushed inward.

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Schatzker Type 3 Fracture

A fracture characterized by depression of the lateral tibial plateau, without any split in the bone.

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Schatzker Type 4 Fracture

A fracture involving a split in the medial side of the tibial plateau.

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Schatzker Type 5 Fracture

A fracture involving both the medial and lateral tibial plateaus, affecting both condyles of the tibia.

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Schatzker Type 6 Fracture

A fracture where there's a separation between the metaphysis and diaphysis of the tibia, often involving significant soft tissue injury.

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Low-energy Tibial Plateau Fractures

Tibial plateau fractures classified as Types I to III are considered low-energy injuries, often occurring due to minor trauma.

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High-energy Tibial Plateau Fractures

Tibial plateau fractures categorized as Types IV to VI are high-energy injuries, usually resulting from significant forces acting on the knee.

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Open Reduction and Internal Fixation (ORIF)

A common surgical technique for repairing tibial plateau fractures, involving open exposure of the fracture site and using screws or plates to secure the broken bones.

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Computed Tomography (CT) Scan

A crucial imaging technique used in the diagnosis and management of tibial plateau fractures, providing detailed images of the bone and surrounding tissues.

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Ankle Brachial Index (ABI)

A medical measurement used to assess blood flow in the ankle compared to the arm, aiding in detecting potential vascular injuries, such as those arising from Schatzker Type 4 fractures.

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Compartment Syndrome

A complication that can occur after tibial plateau fractures, especially types 4 and 6, characterized by increased pressure within the muscle compartments of the leg, potentially damaging tissues and nerves.

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Study Notes

Tibial Plateau Fracture Classifications

  • Schatzker Classification categorizes tibial plateau fractures into six types:
    • Type 1: Lateral split
    • Type 2: Lateral split with depression
    • Type 3: Lateral depression only
    • Type 4: Medial split
    • Type 5: Bicondylar
    • Type 6: Metaphyseal-diaphyseal dissociation
  • Hohl and Moore Classification provides five types:
    • Type 1: Coronal split
    • Type 2: Entire condyle
    • Type 3: Lateral plateau rim avulsion
    • Type 4: Rim compression
    • Type 5: Four-part fractures

Associated Injuries

  • Types I to III are classified as low-energy injuries, while Types IV to VI are high-energy injuries.
  • Type I primarily affects younger individuals and is commonly linked to medial collateral ligament injuries.
  • Type III is rare and typically occurs in older individuals or those with osteopenia.

Common Intra-articular Injuries and Classifications

  • Schatzker Type 2 fractures frequently result in lateral meniscus tears.
  • Type 4 fractures are regarded as the equivalent of a knee dislocation.

Vascular Considerations

  • With Schatzker Type 4 fractures, there is a high risk of popliteal artery injury.
  • If there is a notable difference in palpable pulse strength, an Ankle Brachial Index (ABI) test should be performed, where normal values are greater than 0.9.

Complications and Risks

  • Schatzker Types 4 and 6 fractures have a strong association with compartment syndrome.
  • Post-traumatic arthritis is the most common complication following tibial plateau fractures.

Operative Indications for Surgery

  • Surgery is indicated with an articular step-off greater than 3mm, although nonoperative management may be sufficient for up to 8mm step-off in some cases.
  • Condylar widening greater than 5mm, all bicondylar and medial plateau fractures, open fractures, and varus/valgus instability necessitate surgery.

Imaging and Surgical Techniques

  • A CT scan should be performed after external fixator application to enhance surgical planning through ligamentotaxis.
  • Calcium phosphate is typically used to fill metaphyseal voids during open reduction and internal fixation (ORIF), known for its high compressive strength.
  • Calcium sulfate, while used as a substitute, has a high rate of subsidence and drainage.

Restoration of Alignment Factors

  • Following ORIF of tibial plateau fractures, the critical factors to restore include length, mechanical alignment, and rotation.

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Description

Test your knowledge on tibial plateau fractures with this comprehensive quiz. Explore the different classifications, including the Schatzker and Hohl and Moore systems. Perfect for students and professionals in the medical field.

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