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Figure A
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15/3316
Figure B
70%
2328/3316
Figure C
2%
60/3316
Figure D
67/3316
Figure E
25%
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Figure B represents a medial plateau fracture/dislocation pattern (Schatzker IV). This fracture typically requires more energy to occur than the corresponding lateral plateau injury, which is due to the more dense bone on the medial side. A fracture-dislocation of the knee must be suspected with these injuries, as the femur will sometimes follow the displaced medial tibial condyle. Along with a proper vascular exam, ankle brachial indices (ABI) must be immediately taken and if abnormal further vascular testing is warranted. Furthermore, these injuries which are a hybrid of a dislocation and a fracture will often have a benign appearance on radiographs, but a high rate of vascular complications. Berkson et al present a review article and they stress the importance of safeguarding tissue vascularity and while emphasizing joint reduction and restoration of the mechanical axis of the limb. Ottolenghi et al in their review article showed a vascular injury rate of 2% for tibial plateau fractures. Stark et al in their review showed a very high incidence of acute compartment syndrome in Schatzker IV and VI injuries. In their series, 18% of Schatzker VI and 53% of Shatzker IV fractures developed compartment syndrome.
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