Tibial Plateau Fractures Pathway Posted: 7/2/2022 ID: (C102065)

Tibial Plateau Fracture in 36F

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PRESENTATION
7
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POLLS
10,285
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OUTCOMES
19
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VIDEOS
3
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EVIDENCE
38
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Comments
149
CASE DESCRIPTION
AGE 36 / Female
CC Right knee pain
HPI A 36-year-old female presents to the ED after a bicycle crash with right knee pain. She is very stoic and refuses any pain medication for her injuries. She denies any other injuries. Denies numbness or tingling of the foot.
PMH PMH: non-contributory
PE Focused physical examination of the right lower extremity reveals significant swelling and bruising with firm compartments. The patient is TTP over the proximal tibia. She is neurovascularly intact. Her Diastolic BP is 50 mm Hg. Needle compartment measurements are: Anterior - 34 mm Hg Lateral - 34 mm Hg Superficial Posterior - 25 mm Hg Deep Posterior - 19 mm Hg
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/102065/7c431415-ba48-40d9-b8d9-28d67f027d8f_preop1.jpg https://upload.orthobullets.com/cases/102065/0b056a4f-04fa-4ee5-8702-879ba878629c_preop2.jpg https://upload.orthobullets.com/cases/102065/433e2800-3fbd-43a0-ae3c-8aadce243cd3_preop3.jpg https://upload.orthobullets.com/cases/102065/547f266b-8197-437c-89e1-062c69be0496_preop4.jpg https://upload.orthobullets.com/cases/102065/93b1e46a-753c-46ac-a302-b3579ce83293_preop5.jpg https://upload.orthobullets.com/cases/102065/10f876eb-6f2b-44f3-9b5b-67d90514ab90_preop6.jpg https://upload.orthobullets.com/cases/102065/c717efac-0990-4fc2-b2d1-108921d6f270_preop7.jpg
POLLS
OB Community
1) In addition to the plain film radiographs, would you obtain any additional imaging to guide management?
Other
2) Would you use a classification system for this injury to guide management?
Other
3) Based on the patient's presentation and clinical exam, would you have checked intra-compartmental pressures?
Other
4) How would you manage this patient?
Other
5) If you choose Operative management, and assuming the patient presents to the ED at 7 pm, when would you proceed with surgery?
Other
6) If you choose Operative management, and given the patient's clinical presentation, would you elect to stabilize this patient provisionally prior to definite fixation?
Other
7) If you choose Operative management and would perform a fasciotomy, how many incisions would you use for the fasciotomy?
Other
8) If you choose Operative management and would perform a fasciotomy, when would you plan on definitive fixation?
Other
9) If you choose Operative management, how would you definitively treat this fracture?
Other
10) If you choose Open Reduction and Internal Fixation (ORIF) for definitive management, would you do it in 1 or 2 stages?
Other
11) If you choose Open Reduction and Internal Fixation (ORIF), what surgical approach(es) would you choose?
Other
12) If you choose Operative management and attained the construct shown below, what would be your postoperative weight-bearing status?
Other
CASE OUTCOMES
PROCEDURE 1: Right knee spanning external fixation + 4-compartment fasciotomy (through single lateral incision)
Intra-procedure P1
https://upload.orthobullets.com/cases/102065/a6f02101-7e32-4e91-9fb7-b14ad42854f2_picture1.jpg https://upload.orthobullets.com/cases/102065/2be9d676-9420-4ce7-b37c-bf2edb9ecc4a_picture2.jpg
Post-procedure P1
https://upload.orthobullets.com/cases/102065/199774df-1271-4d5d-8f03-395144efd2f8_picture1.jpg https://upload.orthobullets.com/cases/102065/615a2e2d-c905-4f90-aca0-bade4e9f4e92_picture2.jpg
PROCEDURE 2: Open reduction and internal fixation of right tibial plateau fracture (2 stages)
Intra-procedure P2
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Post-procedure P2
https://upload.orthobullets.com/cases/102065/ae34ff7c-5b5e-409e-ae11-e4fd597c4244_postop1.jpg https://upload.orthobullets.com/cases/102065/4db31e14-042a-4e0a-b051-47d5a3e63e26_postop2.jpg https://upload.orthobullets.com/cases/102065/816a8c6a-dfce-4aa4-9c62-256fa6cc09ad_postop4.jpg https://upload.orthobullets.com/cases/102065/df1cba31-2d5a-434f-a57e-eb9745827510_postop_6.jpg https://upload.orthobullets.com/cases/102065/d56d91a3-4b5d-49f4-a33b-1999fb012fd9_postop_7.jpg https://upload.orthobullets.com/cases/102065/b539ab79-3d7a-4300-a9ca-e656f06a01de_postop_6_weeks.jpg
VIDEOS & PODCASTS (3)
EVIDENCE (38)
EXPERT COMMENTS