Updated: 8/22/2022

Tibial Plateau Fractures

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  • Summary
    • Tibial Plateau fractures are periarticular injuries of the proximal tibia frequently associated with soft tissue injury.
    • Diagnosis is made with knee radiographs but frequently require CT scan for surgical planning.
    • Treatment is often ORIF in the acute setting versus delayed fixation after soft tissue swelling subsides. 
  • Epidemiology
    • Incidence 
      • 1-2% of all fractures
      • 10.3 per 100,000 people annually 
    • Demographics
      • mean age 52
      • bimodal distribution
        • males in 40s (high-energy trauma)
        • females in 70s (low energy falls)
    • Location
      • lateral plateau 70-80%
      • bicondylar 10-30%
      • medial plateau 10-20%
  • Etiology
    • Mechanism
      • Vector of applied load, amount of energy, and quality of bone determine type of fracture
        • valgus load 
          • lateral plateau
        • varus load
          • medial plateau
        • axial load
          • bicondylar 
        • combination
          • fracture dislocation 
          • high energy
          • usually medial-sided plateau fractures 
          • frequently associated with soft tissue injuries
        • low energy
          • usually lateral plateau fractures
    • Associated conditions
      • meniscal tears
        • lateral meniscal tear
          • more common than medial
          • associated with Schatzker II fracture pattern
          • associated with >10mm articular depression
          • associated with >6mm condylar widening
        • medial meniscal tear
          • most commonly associated with Schatzker IV fractures
      • ACL injuries
        • more common in type IV and VI fractures (25%)
      • compartment syndrome
      • neurovascular injury
        • commonly associated with Schatzker IV fracture-dislocations
        • common peroneal nerve is most common nerve injury 
  • Anatomy
    • Osteology
      • lateral tibial plateau
        • convex in shape
        • proximal to the medial plateau
        • less dense bone 
      • medial tibial plateau
        • concave in shape
        • distal to the lateral tibial plateau
      • alignment of proximal tibia
        • posterior tibial slope 
          • 6-10 deg
        • varus slope 
          • 3 deg relative to mechanical axis of tibia
    • Ligaments
      • ACL
        • inserts anteriorly between tibial spines
        • primary restraint against anterior tibial translation
        • secondary stabilizer of tibial rotation
      • PCL
        • inserts on posterior tibial sulcus below articular surface
        • primary restraint to posterior tibial translation  
      • MCL
        • two components
          • superficial MCL
            • broad insertion on proximal tibia deep to pes anserinus
            • primary stabilizer of valgus stress
          • deep MCL
            • attaches to medial meniscus 
            • secondary stabilizer to valgus stress
      • LCL
        • inserts on anterolateral aspect of fibular head
        • primary restraint to varus stress at 30 deg
    • Meniscus
      • lateral meniscus
        • covers larger portion of articular surface
        • more mobile
          • easier to assess articular surface laterally through submeniscal arthrotomy due to mobility of meniscus
      • medial meniscus 
        • less mobile due to coronary ligaments
    • Muscles
      • 4 compartments in lower leg
        • anterior compartment
        • lateral compartment 
        • superficial posterior 
        • deep posterior 
    • Tendons
      • patellar tendon
        • inserts anteriorly on tibial tubercle 
      • iliotibial band 
        • inserts on anterolateral aspect of proximal tibia at Gerdy's tubercle
      • hamstring tendons
        • pes anserine insert on anteromedial aspect of proximal tibia
    • Neurovascular structures
      • popliteal artery runs just posterior to knee capsule and bifurcates
        • anterior tibial artery
        • posterior tibial artery 
      • tibial nerve
        • courses posteriorly along with popliteal artery 
        • sensory: plantar aspect of foot
        • motor: innervates posterior compartments which control ankle plantarflexion and inversion of foot 
      • common peroneal nerve
        • course around fibular neck 
        • two branches
          • superficial peroneal nerve
            • sensory: dorsum of foot (except first dorsal webspace) 
            • motor: innervates lateral compartment which controls ankle eversion 
          • deep peroneal nerve
            • sensory: first dorsal webspace of foot
            • motor: innervates anterior compartment which controls ankle dorsiflexion
    • Biomechanics 
      • medial tibial condyle 
        • bears 60% of load through knee
      • lateral tibial condyle
        • bears 40% of load through knee
    • Kinematics
      • flexion-extension 0-140 degrees
        • functional ROM for walking 0-70 degrees
      • posterior femoral rollback
        • screw-home mechanism
          • medial tibial plateau is concave creating a pivot point
          • lateral plateau is convex allowing for rollback of femur during flexion
        • net effect
          • influences amount of terminal knee flexion
          • tibia externally rotates with knee extension 
  • Classification
    • Schatzker classification
      • Schatzker Classification
      • Type I
      • Lateral split fracture
      • young patient with strong subchondral bone
      • Lateral Split-depressed fracture
      • most common 
      • Type III
      • Lateral Pure depression fracture
      • uncommon, elderly osteoporotic 
      • Medial plateau fracture
      • associated fx-dislocation
      • high rate of NV and ligamentous injuries
      • Type V
      • Bicondylar fracture
      • tibial spines remain continuous with shaft
      • Type VI
      • Metaphyseal-diaphyseal disassociation
      • significant soft-tissue injury
    • Hohl and Moore Classification
      • Useful for
        • true fracture-dislocations
        • fracture patterns that do not fit into the Schatzker classification (10% of all tibial plateau fractures)
        • fractures associated with knee instability
      • Hohl and Moore Classification of proximal tibia fracture-dislocations
      • Type I
      • Coronal split fracture
      • Type II
      • Entire condylar fracture
      • Type III
      • Rim avulsion fracture of lateral plateau
      • Type IV
      • Rim compression fracture
      • Type V
      • Four-part fracture
    • 3-column concept
      • tibial plateau divided into 3 columns
        • medal column
        • lateral column
        • posterior column
      • utility 
        • includes posterior plateau fractures that are not considered in Schatzker classification
        • helps determine fixation strategy  
  • Presentation
    • History
      • mechanism of injury 
        • high-energy vs low-energy
      • unable to bear weight after injury 
      • baseline functional status 
      • comorbidities 
    • Physical exam
      • inspection
        • look circumferentially to rule-out an open injury
        • assess soft-tissues for timing of operative intervention
      • palpation
        • evaluate for compartment syndrome 
      • varus/valgus stress testing
        • any laxity >10 degrees indicates instability
        • often difficult to perform or deferred in acute setting given pain
        • stability assessed in full extension 
      • neurovascular exam
        • perform ankle-brachial index if any asymmetry in pulses
          • ABI <0.9 proceed with arteriogram 
        • assess tibial and common peroneal nerve function
  • Imaging
    • Radiographs
      • recommended views
        • AP
        • lateral
        • oblique
          • oblique is helpful to determine amount of depression
      • optional views
        • plateau view
          • 10 degree caudal tilt to match posterior tibial slope
      • findings
        • on AP
          • depressed articular surface
          • sclerotic band of bone indicating depression 
          • abnormal joint alignment
          • fracture plane involving medial/lateral plateau
        • on lateral
          • posteromedial fracture lines must be recognized
          • abnormal tibial slope
    • CT scan
      • indication
        • negative radiographs with high index of suspicion for tibial plateau fracture
        • preoperative planning 
          • obtain after ex-fix if definitive fixation delayed if soft-tissues are not amenable for surgery
      • findings
        • articular depression
        • degree of comminution 
        • fracture plane and location 
          • posterior coronal split fracture best appreciated on axial and sagittal views 
        • lipohemarthrosis indicates an occult fracture
    • MRI
      • indications
        • not well established
        • identify meniscal and ligamentous pathology
        • occult fractures 
  • DIFFERENTIAL
    • Distal femur fracture
    • Knee dislocation
    • Patella instability 
    • Patella fracture
    • Patella tendon rupture
    • Quadriceps tendon rupture
    • ACL tear
    • Meniscus tear 
  • Treatment
    • Nonoperative
      • closed reduction / immobilization
        • indications
          • minimally displaced split or depressed fractures
          • low energy fracture stable to varus/valgus alignment
          • nonambulatory patients
          • significant comorbidites that preclude surgical intervention
        • modalities
          • patella-tendon-bearing (PTB) cast
          • knee immobilizer
          • hinged knee brace
    • Operative
      • ORIF (acute vs staged) 
        • indications
          • articular depression > 5-10 mm
          • condylar widening > 5mm
          • varus/valgus instability >10 deg
          • medial plateau fractures
          • bicondylar fractures
        • timing
          • acute ORIF
            • lower-energy fractures with mild swelling 
          • temporizing knee-spanning external fixation w/ delayed ORIF
            • significant soft tissue injury/swelling
            • polytrauma
        • outcomes
          • restoration of joint stability is strongest predictor of long-term outcomes
          • postoperative infection after ORIF associated with
            • male gender
            • smoking
            • pulmonary disease
            • bicondylar fracture patterns
            • intraoperative time over 3 hours
          • timing of definitive fixation (before, during or after) relative to fasciotomy closure does not increase the risk of infection
          • worse results with
            • ligamentous instability
            • meniscectomy
            • alteration of limb mechanical axis > 5 degrees
      • external fixation/Ilizarov +/- limited open/percutaneous fixation of articular segment
        • indications
          • severe open fracture with marked contamination
          • highly comminuted fractures where internal fixation not possible
        • outcomes
          • higher malunion rates
      • arthroplasty
        • indications
          • consider in patients >65-years-old with osteoporotic bone
        • outcomes
          • earlier time to weight bearing
          • improved outcomes for primary TKA compared to TKA for failed ORIF
  • Techniques
    • Closed reduction / immobilization
      • technique
        • NWB or PWB in a hinged-knee brace for 8-12 weeks
        • early passive ROM is important to maintain motion
    • Knee-spanning external fixation (temporary)
      • technique
        • place pins outside area of planned definitive fixation
          • two 5-mm half-pins in femur and two in tibia shaft
        • axial traction applied to fixator
          • indirect reduction of fracture through ligamentotaxis 
          • fixator is locked in slight flexion to avoid tensioning posterior NV structures
      • advantages
        • allows soft tissue swelling to decrease before definitive fixation
        • decreases rate of infection and wound healing complications
        • restores length and alignment which helps to better characterize fracture on preop CT 
      • findings
        • transient increase in leg compartment pressures during external fixator placement
          • not been shown to increase risk of compartment syndrome
    • External fixation with limited internal fixation (definitive)
      • technique
        • reduce articular surface either percutaneously or through small incisions
        • stabilize reduction with percutaneous lag screws or wires
          • must keep wires >14mm from joint to avoid intracapsular pin placement 
      • pros
        • minimizes soft tissue insult
      • cons
        • pin site complications
        • arthrofibrosis 
          • incidence as high as 15% after temporizing external fixator 
        • high malunion rates
    • Open reduction internal fixation
      • goals
        • restore alignment
          • coronal
          • sagittal
          • tibial slope
        • normal condylar width
        • congruent articular surface
        • stable knee
        • minimize additional soft tissue trauma
      • approach
        • anterolateral approach (most common)
          • supine
          • lazy S or hockey stick incision centered over Gerdy's tubercle
          • elevate anterior compartment musculature and IT band
          • submeniscal arthrotomy to assess articular surface and meniscus tear
        • posteromedial incision
          • supine with leg in figure-4 or prone
          • interval between pes anserinus and medial head of gastrocnemius
          • can be extensile and access posterolateral column
            • release medial head of gastrocnemius off femur
            • elevate soleus and popliteus 
          • articular surface not routinely visualized directly
            • fluoroscopically or arthroscopically 
        • posterolateral approach
          • prone or lateral
          • biceps and peroneal nerve retracted lateral
          • lateral gastroc and soleus retracted medial 
        • fibular neck osteotomy
          • posterolateral access infrequently used due higher risk of NV complication
        • posterior
          • can be used for posterior shearing fractures
        • midline incision (if planning TKA in future)
          • can lead to significant soft tissue stripping and should be avoided
        • dual surgical incisions with dual plate fixation
          • indications
            • bicondylar tibial plateau fractures
      • reduction
        • assess reduction 
          • submeniscal arthrotomy
          • fluoroscopically 
          • arthroscopically 
        • depressed fragments
          • open fracture split and elevate ("open the book")
          • create cortical window and elevated with bone tamps
        • fill metaphyseal void
          • three main options
            • autograft (ICBG - rare)
            • allograft (cancellous chips) 
            • bone graft substitutes
              • calcium phosphate cement
                • high compressive strength for filling metaphyseal void
                  • less subsidence than ICBG
                • osteoconductive  
                • biodegradable 
                • highly porous 
      • internal fixation
        • absolute stability constructs should be used to maintain the joint reduction
        • screws
          • can be used in isolation but often used in conjunction with plate fixation 
            • isolated depression 
            • simple split fracture 
          • options
            • raft screws
              • placed in subchondral bone parallel to joint surface to support elevated articular fragments
            • lag screws
              • placed perpendicular to plane of split fractures
        • plate fixation
          • conventional non-locking plates
            • buttress plates best indicated for partial articular fractures 
              • posteromedial fractures
              • simple split 
          • peri-articular locking plates
            • fixed angle mitigates risk of varus collapse
              • comminuted fractures
              • osteoporotic bone
      • postoperative
        • hinged knee brace with early passive ROM
          • gentle mechanical compression on repaired osteoarticular segments improves chondrocyte survival
        • NWB or PWB for 8 to 12 weeks
  • Complications
    • Post-traumatic arthritis
      • incidence
        • 25-35%
          • 5-7% undergo TKA at 10+ years
      • risk factors for arthritis
        • meniscectomy
        • malalignment > 5 deg
        • instability 
      • risk factors for future TKA
        • age
        • bicondylar fracture
        • increasing comorbidities
    • Compartment syndrome
      • incidence
        • 7-20%
      • risk factors
        • Schatzker type IV
        • high-energy mechanism
        • associated fibula fracture
        • fracture length
        • associated plateau-shaft injury
      • treatment
        • emergent fasciotomy
    • Infection
      • incidence 
        • 2-11%
      • risk factors
        • poor surgical timing based on swelling
        • open fractures
        • longer operative time
      • treatment
        • irrigation and debridement + IV abx
        • removal of hardware if loose or grossly infected
          • ex-fix and staged revision ORIF 
        • retain hardware if fracture still healing and implant still providing stability
    • Nonunion/malunion
      • incidence 
        • 2-4%
          • uncommon due to rich blood supply of cancellous bone
      • risk factors 
        • Schatzker type VI (metaphyseal-diaphyseal junction)
        • comminution
        • unstable fixation
      • treatment
        • revision osteosynthesis augmented with bone graft 
    • Knee stiffness 
      • incidence
        • 10-25%
      • risk factors
        • increasing age
        • higher BMI
        • severity of fracture
        • prolonged immobilization
        • involvement of tibial eminence
        • polytrauma
      • treatment
        • arthroscopic lysis of adhesions with MUA
          • indicated if unable to achieve 90 deg of flexion within 4 weeks
    • Loss of reduction
      • incidence
        • 5-30%
      • risk factors
        • inadequate fixation
        • severity of fracture
        • osteoporosis
      • treatment
        • revision ORIF to address inadequate fixation
          •  i.e. posteromedial buttress plate for coronal fracture not captured with lateral plate only 
    • Deep vein thromobosis
      • incidence 
        • nonoperative 9%
        • operative 6%
  • Prognosis
    • Mortality rate
      • 5% at 1 year
    • Return to work
      • 70-90% at 1 year 
        • residual dysfunction or reduced work load is common 
    • Mean ROM
      • 10-145 degrees at 1 year

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(SBQ18TR.21) A 27-year-old sustains a high-speed moped injury and presents with the injury depicted in Figures A through E. Which of the following correctly describes the interval classically exploited for definitive reduction and fixation in the surgical approach for the medial-sided injury?

QID: 211331
FIGURES:

Between the superficial MCL and medial head of the gastrocnemius

13%

(166/1257)

Between the sartorius and soleus

1%

(16/1257)

Between the gracilis and semitendinosus

3%

(43/1257)

Between the posterior oblique ligament and soleus

1%

(13/1257)

Between the pes anserinus and medial head of the gastrocnemius

81%

(1015/1257)

L 2 A

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(OBQ18.212) A patient presents with the injury shown in figures A and B. What has been associated with the technique depicted in figures C and D?

QID: 213108
FIGURES:

Longer operative times

12%

(254/2136)

Increased deep surgical infection rates

15%

(323/2136)

Unacceptably high malunion/nonunion rates

32%

(684/2136)

Slower early return to function

28%

(599/2136)

Longer hospital stays

12%

(263/2136)

N/A A

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(OBQ16.128) Which of the following is the most significant risk factor for lateral meniscal tears associated with lateral tibial plateau fractures?

QID: 8890

Age greater than 50

2%

(59/2794)

Female sex

1%

(29/2794)

Ipsilateral calcaneus fracture

1%

(21/2794)

Greater than 10mm of articular depression

91%

(2534/2794)

Schatzker I fracture pattern

5%

(132/2794)

L 1 A

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(OBQ13.156) A 44-year-old female sustains the injury shown in Figures A and B as the result of a motor vehicle collision. She undergoes immediate four compartment leg fasciotomy and placement of a spanning external fixator. A post-fixator CT scan image is shown in Figure C. After allowing her soft tissues to improve, the optimal definitive stabilization of this fracture is which of the following?

QID: 4791
FIGURES:

Continued use of knee-spanning external fixator

1%

(72/5180)

Conversion of external fixator to a simple hinged knee fixator

2%

(98/5180)

Conversion to intramedullary nailing

0%

(15/5180)

Open reduction and internal fixation with a lateral locked plate

1%

(46/5180)

Open reduction and internal fixation with medial and lateral plates

95%

(4925/5180)

L 1 A

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(OBQ13.102) Which of the following injuries is most likely associated with the fracture seen in Figure A?

QID: 4737
FIGURES:

Medial meniscal tear

1%

(49/4807)

Lateral meniscal tear

89%

(4285/4807)

Lateral collateral ligament rupture

3%

(136/4807)

Medial collateral ligament rupture

6%

(279/4807)

Posterior cruciate ligament rupture

1%

(30/4807)

L 2 A

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(OBQ13.132) An ankle-brachial index is most commonly indicated after sustaining which of the following fracture patterns, seen in Figures A-E?

QID: 4767
FIGURES:

Figure A

0%

(17/3832)

Figure B

22%

(849/3832)

Figure C

71%

(2704/3832)

Figure D

1%

(52/3832)

Figure E

5%

(196/3832)

L 2 A

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(SBQ12TR.21) A 35-year-old female presents with the orthopaedic injuries shown in Figures A-D following a high-speed motor vehicle collision. She is also found to have a right-sided diaphragmatic hernia (Figure E) and a stable subarachnoid hemorrhage. The femoral and tibial plateau fractures are open with no gross contamination, and there is an ipsilateral Morel-Lavelle lesion of the left thigh. What is the most appropriate initial management of the patient’s injuries in addition to debridement and irrigation of the open injuries?

QID: 3936
FIGURES:

Application of a knee immobilizer, splinting of the ankle and forearm

1%

(29/1979)

External fixation of the femur and tibial plateau, splinting of the ankle and forearm

85%

(1691/1979)

Retrograde intramedullary nailing of the femur, limited internal fixation of the tibial plateau, splinting of the ankle and forearm

7%

(136/1979)

External fixation of the femur, ORIF of the tibial plateau, splinting of the ankle and forearm

1%

(22/1979)

Retrograde intramedullary nailing of the femur, ORIF of the tibial plateau, ORIF of the ankle and forearm

4%

(87/1979)

L 1 B

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(SBQ12TR.100) Figure A shows an acute, isolated and closed, left knee injury in a 40-year-old male struck by a motor vehicle. What would be the most appropriate surgical fixation for this injury?

QID: 4015
FIGURES:

Definitive external fixation

0%

(5/2553)

Temporary external fixation then lateral percutaneous screws

2%

(48/2553)

Lateral nonlocking plate +/- bone graft substitutes

87%

(2232/2553)

Medial and lateral locking plate +/- bone graft substitutes

3%

(84/2553)

Lateral percutaneous screws with assisted arthroscopy

6%

(163/2553)

L 1 B

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(OBQ12.209) A 32-year-old male sustains the injury shown in Figures A through D as the result of a high-speed motorcycle collision. He initially undergoes spanning external fixation and returns to the office for soft tissue evaluation prior to his definitive surgery. During this visit, you discuss that the most appropriate fixation is which of the following?

QID: 4569
FIGURES:

Lateral precontoured locked plating

1%

(61/5043)

Posterior buttress plating

64%

(3247/5043)

Medial antiglide plating

12%

(628/5043)

Anterolateral and posteromedial plating

20%

(989/5043)

Posterolateral neutralization plating

1%

(68/5043)

L 3 B

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(OBQ12.139) A 45-year-old patient sustains the injury shown in figure A. What radiographic finding most highly suggests a lateral meniscal injury?

QID: 4499
FIGURES:

Joint depression of 3mm

37%

(1866/5091)

Ipsilateral femoral shaft fracture

1%

(39/5091)

Joint widening of 6mm

48%

(2458/5091)

Ipsilateral tibial shaft fracture

1%

(34/5091)

Displaced tibial spine fracture

13%

(669/5091)

L 5 B

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(OBQ12.261) A 23-year-old healthy male was involved in a motor vehicle collision and sustained the injury seen in Figure A. Physical examination after ORIF of the plateau fracture revealed a Grade 3 Lachman, varus laxity at both 0 and 30 degrees of knee flexion, and 15 degrees of external rotation asymmetry at 30 degrees of knee flexion. Which of the following structures (indicated with asterisk*) must be surgically repaired to restore stability to the knee?

QID: 4621
FIGURES:

Figure B

4%

(102/2547)

Figure C

52%

(1314/2547)

Figure D

26%

(650/2547)

Figure E

5%

(121/2547)

Figure F

13%

(342/2547)

L 4 B

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(OBQ12.22) A 32-year-old man sustains the knee injury seen in Figure A after falling from a ladder. Which of the following options is the most biomechanically stable and appropriate definitive surgical treatment?

QID: 4382
FIGURES:

Spanning knee external fixation

1%

(50/3948)

Lateral plateau locking plate

1%

(54/3948)

Posteromedial locking plate

1%

(37/3948)

Lateral plateau percutaneous lag screws and posteromedial plate

4%

(162/3948)

Lateral plateau and posteromedial plating

92%

(3622/3948)

L 1 B

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(OBQ11.212) Which of the following tibial plateau fractures would be most appropriately treated by buttress plating alone?

QID: 3635
FIGURES:

Figure A

0%

(9/2280)

Figure B

2%

(51/2280)

Figure C

1%

(17/2280)

Figure D

94%

(2141/2280)

Figure E

2%

(48/2280)

L 1 A

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(OBQ11.71) A 38-year-old male suffers the injury shown in Figure A. During operative fixation, free osteoarticular fragments are encountered and reconstruction of these pieces is attempted. Postoperatively, which of the following will have the most beneficial effect on the healing potential of the surviving chondrocytes within these reconstructed articular segments?

QID: 3494
FIGURES:

Gentle compressive loading of the affected joint through early range of motion exercises

91%

(3235/3566)

Strict joint immobilzation for three weeks

4%

(147/3566)

Shear loading of the affected joint

1%

(41/3566)

Joint distraction with a spanning external fixator for three weeks

3%

(107/3566)

Glucosamine chondroitin sulfate supplementation

1%

(21/3566)

L 1 B

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(OBQ10.158) A 58-year-old man injures his knee in a high-speed motor vehicle collision. Radiographs and CT are shown in Figures A through C. What is the most appropriate surgical plan based on the images provided?

QID: 3246
FIGURES:

ORIF with medial and lateral plating with grafting of metaphyseal defect

1%

(14/986)

ORIF with lateral plating with grafting of metaphyseal defect

91%

(893/986)

ORIF with medial plating

1%

(7/986)

ORIF with lateral plating

5%

(50/986)

Percutaneous articular fragment reduction and screw fixation

2%

(16/986)

L 1 A

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(OBQ10.175) A 21-year-old male sustains the injury shown in Figures A through D. Which of the following is the most appropriate definitive treatment of this injury?

QID: 3268
FIGURES:

Spanning external fixation

0%

(11/2361)

Lateral locking plate

2%

(55/2361)

Lateral buttress plate

3%

(70/2361)

Posteromedial buttress plate

93%

(2199/2361)

Medial bridging plate

1%

(19/2361)

L 1 C

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(OBQ10.65) Vascular complications are most commonly seen with which of the following fractures about the knee?

QID: 3152
FIGURES:

Figure A

0%

(12/3076)

Figure B

70%

(2151/3076)

Figure C

2%

(54/3076)

Figure D

2%

(62/3076)

Figure E

26%

(787/3076)

L 1 B

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(OBQ10.176) Lipohemarthrosis of the knee is most likely secondary to which of the following?

QID: 3269

Seronegative monoarticular arthritis

1%

(8/1219)

Patellar tendon rupture

3%

(32/1219)

Medial meniscus tear

4%

(44/1219)

Medial patellofemoral ligament rupture

3%

(34/1219)

Occult fracture

90%

(1097/1219)

L 1 C

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(OBQ09.86) A 53-year-old man sustains the injury seen in figure A and later undergoes open reduction and internal fixation. What variable will most significantly increase his rate of degenerative arthritis in the long-term?

QID: 2899
FIGURES:

Postoperative joint stepoff

39%

(1015/2589)

Alteration of limb mechanical axis

56%

(1459/2589)

Fracture type

3%

(67/2589)

Male sex

0%

(10/2589)

Age greater than 50

1%

(29/2589)

L 1 C

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(OBQ09.166) A large posteromedial tibial plateau fracture pattern, as seen with the bicondylar tibial plateau fracture shown in Figures A and B, is important to recognize because of which of the following factors?

QID: 2979
FIGURES:

Association with posteromedial corner of the knee injury

9%

(78/845)

Association with anterior tibial artery injury

9%

(78/845)

Possible need for dual plate fixation

79%

(667/845)

Possible need for single extensile anterior approach to the knee

1%

(7/845)

Increased risk of deep venous thrombosis

1%

(12/845)

L 2 C

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(OBQ09.118) A 56-year-old carpenter sustains the closed injury seen in Figures A, B, and C. After temporary spanning external fixation is performed and soft tissue conditions improve, what strategy provides the optimal fixation for this fracture pattern?

QID: 2931
FIGURES:

Anatomic lateral locking plate

1%

(36/2492)

Posteromedial and lateral plates

78%

(1938/2492)

Anatomic medial locking plate

7%

(166/2492)

Conversion of the spanning external fixator to a hinged external fixator

0%

(8/2492)

Posterior buttress plate

14%

(338/2492)

L 2 A

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