Questions and Answers
What is the classification of tibial plateau fractures?
What alternative classification may be used for tibial plateau fractures?
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?
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Which Schatzker classification is referred to as a 'knee dislocation' equivalent?
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With Schatzker type 4 tibial plateau fracture, which structure should be examined for injury?
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If a difference in palpable pulse strength is noted, what test should be performed?
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Which types of tibial plateau fractures have a high association with compartment syndrome?
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What are the operative indications for a tibial plateau fracture?
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In a tibial plateau fracture requiring external fixation, when should a CT scan be performed?
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During ORIF, what is commonly used to fill a metaphyseal void?
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What substitute has a high rate of subsidence and drainage if used to fill a metaphyseal void?
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What factors are critical to restore following ORIF of tibial plateau fractures?
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What is the most common complication following tibial plateau fractures?
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Study Notes
Tibial Plateau Fracture Classifications
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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
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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.
