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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?
Association with posteromedial corner of the knee injury
Association with anterior tibial artery injury
Possible need for dual plate fixation
Possible need for single extensile anterior approach to the knee
Increased risk of deep venous thrombosis
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A 45-year-old patient sustains the injury shown in figure A. What radiographic finding most highly suggests a lateral meniscal injury?
Joint depression of 3mm
Ipsilateral femoral shaft fracture
Joint widening of 6mm
Ipsilateral tibial shaft fracture
Displaced tibial spine fracture
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?
Postoperative joint stepoff
Alteration of limb mechanical axis
Age greater than 50
A 28-year-old man is thrown from his motorcycle and sustains the closed injury seen in Figure A. The limb remains neurovascularly intact. What is the most appropriate initial treatment of this injury?
Bulky compressive splint
Open reduction and internal fixation
Closed intramedullary nailing
Spanning external fixation
Hinged spanning external fixation
An ankle-brachial index is most commonly indicated after sustaining which of the following fracture patterns, seen in Figures A-E?
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?
Lateral locking plate
Lateral buttress plate
Medial buttress plate
Medial bridging plate
A 35-year-old male sustains the fracture seen in Figures A and B. Which of the following substances has been shown to result in the least radiographic subsidence when combined with open reduction and internal fixation?
Cancellous allograft bone chips
Autograft iliac crest
Femoral intramedullary reamings
Calcium phosphate cement
Calcium sulfate cement
A 35-year-old male sustains a closed Schatzker VI tibial plateau fracture. Two weeks following external fixation, examination reveals intact sensation, palpable pulses and no soft tissue compromise. An axial CT image is shown in Figure A. What is the optimal surgical plan?
Medial and lateral plate fixation through two approaches
Medial and lateral plate fixation through a single anterior approach
Lateral locking plate fixation
Continued external fixation until union
Multiplanar transarticular external fixator
A 40-year-old female sustains the injury seen in Figure A. What other associated soft-tissue knee injury is most commonly associated with this fracture?
Anterior cruciate ligament midsubstance tear
Horizontal cleavage lateral meniscus tear
Peripheral lateral meniscus tear
Lateral collateral ligament and popliteofibular ligament tear
Lateral meniscus posterior root avulsion
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?
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?
Spanning knee external fixation
Lateral plateau locking plate
Posteromedial locking plate
Lateral plateau percutaneous lag screws and posteromedial plate
Lateral plateau and posteromedial plating
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?
Anatomic lateral locking plate
Posteromedial and lateral plates
Anatomic medial locking plate
Conversion of the spanning external fixator to a hinged external fixator
Posterior buttress plate
In an uninjured proximal tibia which statement best describes the shape and position of the medial tibial plateau relative to the lateral tibial plateau?
More concave and more proximal
More convex and more proximal
More concave and more distal
More convex and more distal
Symetric in conture and more distal
In treating a lateral split-depression type tibial plateau fracture, which of the following adjuncts has been shown to have the least articular surface subsidence when used to fill the bony void?
Crushed cancellous allograft
Autogenous iliac crest
Bisected diaphyseal humeral allograft
Which of the following tibial plateau fractures would be most appropriately treated by buttress plating alone?
A 58-year-old man injures his knee in a high-speed motor vehicle collision. Radiographs and CT are shown in Figures A thru C. What is the most appropriate surgical plan based on the images provided?
ORIF with medial and lateral plating with grafting of metaphyseal defect
ORIF with lateral plating with grafting of metaphyseal defect
ORIF with medial plating
ORIF with lateral plating
Percutaneous articular fragment reduction and screw fixation
Buttress plating is most appropriate in which of the following clinical situations?
Vascular complications are most commonly seen with which of the following fractures about the knee?
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?
Gentle compressive loading of the affected joint through early range of motion exercises
Strict joint immobilzation for three weeks
Shear loading of the affected joint
Joint distraction with a spanning external fixator for three weeks
Glucosamine chondroitin sulfate supplementation
A 27-year-old male is involved in a motor vehicle accident and sustains the injury shown in Figures A through E. The articular surface is depressed 2 mm while there is 3 mm of condylar widening. Valgus instability of the knee is noted. Which of the following is most important to long-term success in surgical treatment of this case?
Restoration of joint stability
Repair of associated meniscal pathology
Surgical fixation within 48 hours of injury
Correction of the articular depression
Tibial condylar diastasis < 3 mm
Lipohemarthrosis of the knee is most likely secondary to which of the following?
Seronegative monoarticular arthritis
Patellar tendon rupture
Medial meniscus tear
Medial patellofemoral ligament rupture
Based on the following radiographs of tibial plateau fractures, which one is most likely to have a concomitant medial meniscus tear?
A 69-year-old female sustains the injuries seen in Figures A and B. This injury is best classified as which of the following?
Schatzker type I tibial plateau fracture
Schatzker type III tibial plateau fracture
Schatzker type IV tibial plateau fracture
Schatzker type V tibial plateau fracture
Schatzker type VI tibial plateau fracture
When elevating the joint surface in the injury pattern seen in Figure A, what material has the highest compressive strength when filling the metaphyseal void?
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HPI - Right knee and leg pain with swelling after a heavy object fell directly onto the right lower limb
What is the best definitive fixation for this patient's injuries?
HPI - Direct trauma to the upper leg
What is the Schatzker classification for this injury?
HPI - 60M present with inability to weight-bear on his right leg following a tibial plateau fracture 8 months ago.
At the time of the fracture, patient underwent ORIF of the fracture with a lateral plate.
ORIF was complicated by a post-operative infection with a discharging sinus.
Hardware removal and debridement was performed 4 months after the initial ORIF.
The infection has now resolved. The wound has healed, no further discharge, CRP = 6.
Bone marrow injection was performed twice, 3 weeks apart, and the patient was kept in a cast for three months.
The patient now presents with an unstable, mobile nonunion of the proximal tibia with pain and inability to weight-bear on the right leg.
Currently in an above knee cast, hyperbaric oxygen sessions have been done.
What further imaging would you order in this patient?