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Tibial Plateau Fractures
Posted: Apr 26 2021 #(C101750)
A

Tibial Plateau Fracture in 25M

HPI

A 25-year-old male presents following a motor vehicle collision in which he sustained an isolated closed left knee injury. He admits to diffuse left knee pain and swelling. He is unable to ambulate. He denies any numbness or tingling of the left leg.

PMH

None

PE

A focused physical examination of the left lower extremity reveals left knee effusion without any open wounds. His compartments are soft and compressible. He is neurovascularly intact.

Poll
1 of 13
1. In addition to standard AP and LAT radiographs of the injured knee, would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
2%
19/689
Yes - additional radiographs (aXR)
0%
3/689
Yes - CT scan of knee (CT)
82%
565/689
Yes - MRI of Knee (MRI)
2%
19/689
Yes - aXR + CT
2%
18/689
Yes - aXR + MRI
0%
6/689
Yes - CT + MRI
5%
39/689
Yes - aXR + CT + MRI
1%
8/689
Outside my area of expertise, best if I don't vote
1%
12/689
2. If you choose Operative management, would you temporize this patient?
I would not choose Operative management
3%
25/659
No - I would perform Immediate Definitive Fixation
32%
217/659
Yes - in a Posterior Splint (or knee immobilizer)
46%
309/659
Yes - with External Fixation
12%
84/659
Yes - with Skeletal Traction
0%
5/659
Outside my area of expertise - best if I don't vote
2%
19/659
3. If you choose Operative management, how would you definitively treat this fracture?
I would not choose Operative management
1%
7/634
Open reduction internal fixation (ORIF) (includes minimally invasive plate) Alone
91%
580/634
External Fixation (includes +/- limited internal fixation) Alone
1%
10/634
Closed Reduction Percutaneous Pinning (CRPP) Alone
1%
10/634
Intramedullary Nail (IMN) (includes +/- limited internal fixation) Alone
0%
2/634
Arthroplasty Alone
0%
1/634
ORIF + IMN
1%
9/634
ORIF + Arthroplasty
0%
0/634
Outside my area of expertise - best if I don't vote
2%
15/634
4. If you choose Open Reduction and Internal Fixation (ORIF), what surgical approach(es) would you choose?
I would Not choose ORIF
0%
4/608
Single - Anterolateral (AL)
22%
136/608
Single - Posteromedial (PM)
1%
9/608
Single - Posterior (P)
0%
2/608
Single - Direct medial (DM)
2%
18/608
Single - Direct Anterior (DA)
3%
22/608
Dual - AL + PM
36%
222/608
Dual - AL + DM
26%
160/608
Dual - DM + Posterior
0%
3/608
Dual - AL + Posterior
0%
3/608
Other Combination
0%
3/608
Outside Outside my area of expertise - best if I don't vote
4%
26/608
5. If you choose Open reduction internal fixation (ORIF), how would you optimize your articular reduction?
I would Not choose ORIF
0%
2/581
Fluoroscopy Alone
20%
117/581
Submeniscal Arthrotomy Alone
8%
50/581
Arthroscopy Alone
2%
12/581
Fluoro + Submeniscal Arthrotomy
49%
288/581
Fluoro + Arthroscopy
14%
83/581
Outside of my area of expertise - best if I don't vote
4%
29/581
6. If you choose Open reduction internal fixation (ORIF), what would be your primary method to assess restoration of the posterior tibial slope?
I would Not choose ORIF
0%
1/545
Comparison to Contralateral Knee Xrays (Contralateral Knee)
8%
45/545
Standard Fluoro
46%
251/545
3D Fluoro
3%
19/545
Arthroscopy
2%
16/545
Intraoperative CT
2%
14/545
Contralateral Knee + Standard Fluoro
30%
164/545
Other / Other combination of above
0%
5/545
Outside my area of expertise - best if I don't vote
5%
30/545
7. If you choose Open reduction internal fixation (ORIF), what plate(s) construct would you use?
I would Not choose ORIF
0%
0/541
Single Plate - Medial
2%
11/541
Single Plate - Lateral
17%
92/541
Single Plate - Posterior
0%
4/541
Dual Plate - Lateral + Medial
62%
336/541
Dual Plate - Lateral + Posterior
11%
60/541
Dual Plate - Medial + Posterior
1%
8/541
Three Plate Construct
1%
7/541
Outside my area of expertise - best if I don't vote
4%
23/541
8. If you choose Open reduction internal fixation (ORIF), would you include subchondral rafting screws?
I would Not choose ORIF
0%
1/519
No - I would not place subchondral rafting screws | I will rely on plate for fixation
43%
226/519
Yes - I would include subchondral rafting screws | placed outside the plate
49%
256/519
Yes - I would include subchondral rafting screws | placed through the plate holes
0%
0/519
Outside my area of expertise - best if I don't vote
6%
36/519
9. If you choose Open reduction internal fixation (ORIF), would you graft the metaphyseal void after restoring the articular surface?
I would Not choose ORIF
0%
2/517
No - I would rely only on the fixation
17%
93/517
Yes - Allograft
21%
112/517
Yes - Autograft
13%
69/517
Yes - Bone Graft Substitute (BGS)
31%
161/517
Yes - Allograft + BGS
7%
38/517
Yes - Autograft + BGS
3%
18/517
Other
0%
1/517
Outside my area of expertise - best if I don't vote
4%
23/517
10. If you choose Open reduction internal fixation (ORIF) with the application of Bone Graft Substitute (BGS), what type would you use?
I would Not choose ORIF with application of Bone graft substitute
12%
64/499
Calcium sulfate
6%
32/499
Calcium phosphate
28%
142/499
Tricalcium phosphate
28%
140/499
Coralline hydroxyapatite
11%
58/499
Other
1%
8/499
Outside my area of expertise - best if I don't vote
11%
55/499
11. If you choose Operative management and attained the construct shown, what would be your immediate postoperative weight-bearing status?
I would Not choose ORIF
0%
1/487
Weight-bearing as tolerated
2%
12/487
Partial/protected (25-50%) weight-bearing
8%
42/487
Touch-down weight-bearing
38%
186/487
Non-weight-bearing
49%
239/487
Outside my area of expertise - best if I don't vote
1%
7/487
12. If you choose Open reduction internal fixation (ORIF) and obtained the final construct shown and made the patient NWB immediately after surgery, when would you begin weight-bearing post-operatively?
I would Not choose ORIF
0%
0/492
1-2 weeks
2%
12/492
3-4 weeks
13%
64/492
5-6 weeks
46%
229/492
7-8 weeks
22%
113/492
9-12 weeks
11%
57/492
>12 weeks
2%
11/492
Outside my area of expertise - best if I don't votede
1%
6/492
13. If you choose Operative management and attained the construct shown, what immediate postoperative range of motion would you allow?
I would Not choose ORIF
0%
1/482
Full AROM + Full PROM
60%
293/482
No AROM, Full PROM
10%
53/482
No AROM, Partial PROM
17%
85/482
No AROM, No PROM
7%
37/482
Outside my area of expertise - best if I don't vote
2%
13/482
PROCEDURE #1

ORIF left tibial plateau

Intra-procedure P1
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