![]() ![]() When should we suspect an occult tibial plateau fracture? If the patient has a large effusion and a mechanism consistent with a tibial plateau fracture (for example, the patient was hit from the side by a car), you can obtain oblique views with the knee internally and externally rotated about 15-20 degrees. How frequently are plain films negative? There isn’t good literature available. ❏ CT scans are useful for determining need for operative intervention. ❏ If moving the big toe up and down causes significant pain, you should be very concerned for compartment syndrome. Type VI fractures are the result of severe stress and result in dissociation of the tibial plateau region from the underlying diaphysis.❏ Tibial plateau fractures from higher energy mechanisms of injury are at increased risk of compartment syndrome.Type V fractures are characterized by split fractures through both the medial and lateral tibial plateaus.Type IV fractures involve the medial tibial plateau and may be split fractures with or without depression.Type III fractures are characterized by depression of the lateral tibial plateau, without splitting through the articular surface.Type II fractures are split fractures with depression of the lateral articular surface and typically are seen in older patients with osteoporosis.No depression is seen at the articular surface. Type I fractures are split fractures of the lateral tibial plateau, usually in younger patients.The Schatzker classification 3 system, described below There are several methods of describing the fractures, including the Schatzker and AO systems. While planning treatment of patients with tibial plateau fractures, the factors that must be considered include the patient's age and physical condition, the presence and degree of plateau depression, the presence and degree of separation of split fragments, and the severity of fracture comminution. However MR imaging in every case would be time consuming and less cost effective. In addition, MR showed significant soft-tissue injuries. The efficacy of MR imaging was compared with CT by some authors 2, which revealed MR imaging was equivalent or superior to two-dimensional CT reconstruction for depiction of fracture configuration in most patients. Thus spiral CT with multiplanar imaging has evolved as the preferred investigation while imaging suspected or proven tibial plateau fractures. Visualisation of split fragments with an oblique plane of fracture is also better by CT. Studies 1 have proved that CT is more accurate than conventional tomography in assessing depressed and split fractures when they involved the anterior or posterior border of the plateau and in demonstrating the extent of fracture comminution. Nondepressed tibial plateau fractures occasionally are difficult to appreciate with standard radiographs. ![]() The presence of these subtle fractures may be inferred by the presence of a lipohemarthrosis on the cross-table lateral radiograph, indicating disruption of an articular surface, most often the tibia. Cross-table lateral and AP may be the only views possible in the trauma setting and the cross-table lateral radiograph may be the most important to detect occult fractures. When imaging knee injuries with bony tenderness, the preferred examination consists of radiographs in multiple obliquities of the knee. ![]()
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