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Tibial Plateau Fractures
Posted: Jun 14 2020 #(C101499)
A

Tibial Plateau Fracture in a 38M

HPI

A 38-year-old male presents with left knee pain after falling off of his skateboard onto a planted foot. He experienced immediate pain and deformity of the left knee.

PMH

None

PE

On exam the left knee skin is intact. There is a moderate intra-articular effusion, mild soft tissue swelling, and the compartments of the leg are soft and compressible. There is TTP over the lateral aspect of the proximal tibia. ROM is 5-90 degrees, limited by pain. There is an intact straight leg raise. Neurovascular status is intact distally.

Poll
1 of 14
1. In addition to the standard AP and LAT radiographs of the knee, what additional imaging would you obtain to guide management?
No - current radiographs are sufficient
4%
31/702
Yes - additional radiographs (aXR)
0%
3/702
Yes - CT scan (CT)
84%
596/702
Yes- MRI (MRI)
3%
22/702
Yes - aXR + CT
3%
24/702
Yes - aXR + MRI
0%
4/702
Yes - aXR + CT + MRI
1%
14/702
Outside my area of expertise - best if I don't vote
1%
8/702
2. If you choose to obtain additional radiographs (aXR), in addition to standard AP and LAT Xrays of the knee, what would get?
I would not get Additional Radiographs (aXR)
60%
287/478
Joint Above + Below (Hip & Ankle)
17%
84/478
Varus/Valgus Stress Radiographs of Injured Knee (Stress)
9%
46/478
Contralateral Uninjured Knee (Other Knee)
5%
27/478
Hip & Knee + Stress
1%
6/478
Stress + Other Knee
0%
4/478
Hip & Knee + Stress + Other Knee
1%
6/478
Other Additional Xrays
0%
4/478
Outside my area of expertise - best if I don't vote
2%
14/478
3. Would you use a classification system for this injury to guide management?
No - a classification system would not help me
13%
93/672
Yes - AO/OTA
8%
58/672
Yes - Schatzker
70%
475/672
Yes - Hohl and Moore
2%
14/672
Yes - Other
1%
7/672
Outside my area of expertise - best if I don't vote
3%
25/672
4. How would you manage this injury?
Nonoperative
1%
11/829
Operative
97%
812/829
Outside my area of expertise - best if I don't vote
0%
6/829
5. If you choose Operative management, what would be your choice for definitive fixation?
I would not choose Operative management
0%
1/811
External fixation only (includes monoplanar, ringed circular fixation, etc)
0%
2/811
External fixation + limited internal fixation (percutaneous screw fixation)
1%
12/811
Open reduction internal fixation (ORIF)
96%
785/811
Outside my area of expertise - best if I dont vote
1%
11/811
6. If you choose Open reduction internal fixation (ORIF), what type of lateral plate fixation would you use?
I would not choose ORIF
0%
1/793
Non-locking plate
13%
110/793
Locking plate
83%
664/793
Outside my area of expertise - best if I don't vote
2%
18/793
7. If you choose Open reduction internal fixation (ORIF), would you include subchondral rafting screws?
I would not choose ORIF
0%
1/765
No - I would rely solely on fixation through the plate
32%
250/765
Yes - I would include rafting screws outside the plate
62%
481/765
Outside my area of expertise - best if I don't vote
4%
33/765
8. If you choose Open reduction internal fixation (ORIF), would you assist your reduction with Knee Arthroscopy?
I would not perform ORIF
0%
2/453
No - I would not use Arthroscopy to assist my reduction
66%
301/453
Yes - I would perform Arthroscopy to assist my reduction
32%
146/453
Outside my area of expertise - best if I don't vote
0%
4/453
9. If you choose Open reduction internal fixation (ORIF), would you perform a submeniscal arthrotomy?
I would not choose ORIF
0%
0/639
No
18%
119/639
Yes
77%
497/639
Outside my area of expertise - best if I don't vote
3%
23/639
10. 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%
0/761
No - I would rely only on the fixation
5%
43/761
Yes - Allograft
26%
201/761
Yes - Autograft
17%
130/761
Yes - Bone Graft Substitute
34%
266/761
Yes - Allograft + Bone Graft Substitute
8%
68/761
Yes - Autograft + Bone Graft Substitute
6%
47/761
Other
0%
1/761
Outside my area of expertise - best if I don't vote
0%
5/761
11. If you choose Open reduction internal fixation (ORIF) with the application of Bone Graft Substitute, what type would you use?
I would not choose ORIF with application of Bone graft substitute
8%
65/742
Calcium sulfate
6%
49/742
Calcium phosphate
35%
262/742
Tricalcium phosphate
28%
211/742
Coralline hydroxyapatite
9%
74/742
Other
2%
20/742
Outside my area of expertise - best if I don't vote
8%
61/742
12. If you choose Open reduction internal fixation (ORIF), would you include any orthobiologics?
I would not choose ORIF
0%
6/726
No - I would not include biologics
77%
565/726
Yes - rhBMP-2
5%
37/726
Yes - rhBMP-7
5%
41/726
Yes - Other
1%
8/726
Outside my area of expertise - best if I don't vote
9%
69/726
13. If you choose Open reduction internal fixation (ORIF) and obtained the final construct shown below, when would you begin weight-bearing post-operatively?
I would not choose ORIF
0%
0/738
1-2 weeks
1%
14/738
3-4 weeks
5%
43/738
5-6 weeks
34%
254/738
7-8 weeks
29%
221/738
9-12 weeks
20%
153/738
>12 weeks
5%
43/738
Outside my area of expertise - best if I don't votede
1%
10/738
14. If you choose Operative management and attained the construct shown below, what immediate postoperative range of motion would you allow?
I would not choose Operative management
0%
3/594
Full AROM + Full PROM
60%
362/594
No AROM, Full PROM
11%
67/594
No AROM, Partial PROM
19%
118/594
No AROM, No PROM
5%
30/594
Outside my area of expertise - best if I don't vote
2%
14/594
PROCEDURE #1

Open reduction and internal fixation of lateral split-depression tibial plateau fracture

Intra-procedure P1
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