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Orthopaedics: Tibia
2021-02-19 12:00 AM
Tibial Plateau Fracture, Mechanism and treatment
Tibial Plateau Fracture
Mechanism
- axial loading (e.g. fall from height)
- femoral condyles are driven into the proximal tibia
- can result from minor trauma in osteoporotic
Clinical Features
- lateral fractures more common than medial
Classification
- Schatzker classification
Investigations
- x-rays: AP, lateral, skyline
Treatment
- if depression on x-ray is <3 mm
straight leg immobilization x 4-6 weeks with progressive ROM weight bearing
- if depression is >3 mm
ORIF often requiring bone grafting to elevate depressed fragment
Specific Complications (see General Fracture Complications)
- ligamentous injuries
- meniscal lesions
- AVN
- infection
Tibial Shaft Fracture
Mechanism
- numerous, including MVA, falls, sporting injuries
Clinical Features
- open vs. closed
- amount of displacement
- neurovascular status
- most commonly fractured long bone
- most common open fracture
Investigations
- x-rays: AP, lateral. skyline
Treatment
- closed
- minimally displaced: straight leg cast x 4-6 weeks with early weight-bearing
- displaced: ORIF with reamed IM nail. plate and screws, or external factor
- open
- external fixation or IM nail
- vascularized coverage of soft tissue defects (often heal poorly)
Specific Complications (see General Fracture Complications)
- high incidence of neurovascular injury and compartment syndrome
- poor soft tissue coverage