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