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Tibial Plateau Fractures
Posted: Dec 22 2015 #(C2467)
A

Tibial Plateau Fx vs PLC Injury

HPI

Patient was skiing when he fell with a twisting mechanism to left ski, had immediate and severe pain in knee. Went to ER where radiographs done. MRI done shortly after. MRI report is shown below.

PMH

None

PE

TTP in lateral knee. Effusion. Unable to perform Lachman, Pivot shift, Dial test secondary to pain.

Poll
1 of 7
1. In addition to the plain radiographs above, what additional imaging studies would you obtain to dictate treatment?
None - plain xrays enough
1%
24/1509
CT scan only
27%
416/1509
MRI only
15%
238/1509
CT scan + MRI
39%
596/1509
Varus-valgus stress xrays
1%
20/1509
CT + Varus-valgus stress xrays
3%
55/1509
MRI + Varus-valgus stress xrays
3%
47/1509
CT + MRI + Varus-valgus stress xrays
7%
113/1509
2. How would you treat the tibia plateau fracture?
Not enough information to decide treatment, need more information.
1%
28/1420
Immobilize knee in full extension with protected weightbearing
3%
53/1420
Hinged knee brace, PWB for 8-12 weeks, and immediate passive ROM
6%
88/1420
Limited open/percutaneous fixation of articular segment
5%
81/1420
ORIF with restoration of joint line
42%
604/1420
ORIF with restoration of joint line with arthroscopic assist
39%
566/1420
3. If performing ORIF of the tibia plateau how would you restore the joint line.
Balloon kyphoplasty
7%
109/1363
Bone tamp
87%
1192/1363
Don't need to restore, it is fine
4%
62/1363
4. Would you, and how would you, augment the subchondral defect?
I would NOT augment subchondral defect
6%
81/1290
Augment with Autogenous Iliac Crest
30%
398/1290
Augment with Allograft Bone Chips
35%
460/1290
Augment with Calcium Phosphate cement (CaPO4)
27%
351/1290
5. If performing ORIF of tibia plateau, what would you use for fixation.
Rafting screws alone (no plate necessary)
10%
134/1268
Non-locking periarticular plate
4%
58/1268
Locking Periarticular plate
30%
390/1268
Non-locking periarticular plate AND rafting screws
12%
162/1268
Locking Periarticular plate AND rafting screws
41%
524/1268
6. How would you treat the Posterolateral corner?
Don't know, need more information (stress radiographs, better exam once plateau healed)
16%
206/1270
Only treat tibia plateau
19%
244/1270
PLC repair now
11%
151/1270
PLC reconstruction now
9%
115/1270
PLC reconstruction later (after plateau healed)
43%
554/1270
7. How would you classify/describe this fracture?
Schatzker I
4%
62/1274
Schatzker II
58%
742/1274
Schatzker III
32%
417/1274
Posterolateral Corner Injury
4%
53/1274
PROCEDURE #1 DOP: 12/24/2015

Rafting screw placement

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OUTCOMES
3 months after
Post-procedure P1
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