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 surgical reduction and fixation in the acute setting versus delayed fixation after soft tissue swelling subsides. Epidemiology demographics bimodal distribution males in 40s (high-energy trauma) females in 70s (falls) location unicondylar vs. bicondylar frequency lateral > bicondylar > medial Etiology Mechanism varus/valgus load with or without axial load high energy frequently associated with soft tissue injuries low energy usually insufficiency fractures Associated conditions meniscal tears lateral meniscal tear more common than medial associated with Schatzker II fracture pattern associated with >10mm articular depression medial meniscal tear most commonly associated with Schatzker IV fractures ACL injuries more common in type IV and VI fractures (25%) compartment syndrome vascular injury commonly associated with Schatzker IV fracture-dislocations Anatomy Osteology lateral tibial plateau convex in shape proximal to the medial plateau medial tibial plateau concave in shape distal to the lateral tibial plateau 3-column concept one column fracture is defined as an independent articular depression with a break in the column zero-column fracture = purely articular anteromedial + posteromedial fractures = 2-column fracture anterolateral fracture + separate posterolateral depression fractures = 2-column fracture Muscles anterior compartment musculature attaches to anterolateral tibia pes anserine attaches to anteromedial tibia Biomechanics medial tibial plateau bears 60% of knee's load Classification Schatzker classification Schatzker Classification Type I Lateral split fracture Type II Lateral Split-depressed fracture Type III Lateral Pure depression fracture Type IV Medial plateau fracture Type V Bicondylar fracture Type VI Metaphyseal-diaphyseal disassociation 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 Presentation History high-energy trauma in young patients low-energy falls in elderly Physical exam inspection look circumferentially to rule-out an open injury palpation consider compartment syndrome when compartments are firm and not compressible varus/valgus stress testing any laxity >10 degrees indicates instability often difficult to perform given pain neurovascular exam any differences in pulse exam between extremities should be further investigated with anke-brachial index measurement Imaging Radiographs recommended views AP lateral oblique oblique is helpful to determine amount of depression optional views plateau view 10 degree caudal tilt findings on AP depressed articular surface sclerotic band of bone indicating compression fx abnormal joint alignment on lateral posteromedial fracture lines must be recognized CT scan important to identify articular depression and comminution findings lipohemarthrosis indicates an occult fracture fracture fragment orientation and surgical planning MRI indications not well established findings useful to determine meniscal and ligamentous pathology Treatment Nonoperative hinged knee brace, PWB for 8-12 weeks, and immediate passive ROM indications minimally displaced split or depressed fractures low energy fracture stable to varus/valgus alignment nonambulatory patients Operative 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 unacceptably high malunion rates usually requires delayed arthroplasty in the setting of highly comminuted fractures in the elderly ORIF indications articular stepoff > 3mm condylar widening > 5mm varus/valgus instability all medial p lateau fxs all bicondylar fxs timing temporizing bridging external fixation w/ delayed ORIF indications significant soft tissue injury 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 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 External fixation (temporary) technique two 5-mm half-pins in distal femur, two in distal tibia axial traction applied to fixator fixator is locked in slight flexion advantages allows soft tissue swelling to decrease before definitive fixation decreases rate of infection and wound healing complications findings transient increase in leg compartment pressures during external fixator placement this has not been shown to increase risk of compartment syndrome External fixation with limited internal fixation (definitive) technique reduce articular surface either percutaneously or with small incisions stabilize reduction with lag screws or wires must keep wires >14mm from joint apply external fixator or hybrid ring fixation post-operative care begin weight bearing when callus is visible on radiographs usually remain in place 2-4 months pros minimizes soft tissue insult permits knee ROM cons pin site complications inappropriately high malunion rates Open reduction, internal fixation approach lateral incision (most common) straight or hockey stick incision anterolaterally from just proximal to joint line to just lateral to the tibial tubercle midline incision (if planning TKA in future) can lead to significant soft tissue stripping and should be avoided posteromedial incision interval between pes anserinus and medial head of gastrocnemius dual surgical incisions with dual plate fixation indications bicondylar tibial plateau fractures posterior can be used for posterior shearing fractures reduction restore joint surface with direct or indirect reduction fill metaphyseal void with autogenous, allogenic bone graft, or bone graft substitutes calcium phosphate cement has high compressive strength for filling metaphyseal void internal fixation absolute stability constructs should be used to maintain the joint reduction screws may be used alone for simple split fractures depression fractures that were elevated percutaneously plate fixation non-locked plates non-locked buttress plates best indicated for simple partial articular fractures in healthy bone locked plates advantages fixed-angle construct less compression of periosteum and soft tissue 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 rate increases with meniscectomy during surgery axial malalignment intra-articular infection joint instability
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Bicondylar Tibial Plateau ORIF with Lateral Locking Plate Orthobullets Team Trauma - Tibial Plateau Fractures Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Tibial Plateau Fracture External Fixation Orthobullets Team Trauma - Tibial Plateau Fractures
QUESTIONS 1 of 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ16.128) Which of the following is the most significant risk factor for lateral meniscal tears associated with lateral tibial plateau fractures? QID: 8890 Type & Select Correct Answer 1 Age greater than 50 2% (53/2509) 2 Female sex 1% (26/2509) 3 Ipsilateral calcaneus fracture 1% (18/2509) 4 Greater than 10mm of articular depression 91% (2272/2509) 5 Schatzker I fracture pattern 5% (122/2509) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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: A B C Type & Select Correct Answer 1 Continued use of knee-spanning external fixator 1% (67/4870) 2 Conversion of external fixator to a simple hinged knee fixator 2% (90/4870) 3 Conversion to intramedullary nailing 0% (13/4870) 4 Open reduction and internal fixation with a lateral locked plate 1% (42/4870) 5 Open reduction and internal fixation with medial and lateral plates 95% (4634/4870) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ13.102) Which of the following injuries is most likely associated with the fracture seen in Figure A? QID: 4737 FIGURES: A Type & Select Correct Answer 1 Medial meniscal tear 1% (46/4583) 2 Lateral meniscal tear 89% (4078/4583) 3 Lateral collateral ligament rupture 3% (126/4583) 4 Medial collateral ligament rupture 6% (278/4583) 5 Posterior cruciate ligament rupture 1% (27/4583) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (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: A B C D E Type & Select Correct Answer 1 Figure A 0% (16/3613) 2 Figure B 22% (792/3613) 3 Figure C 71% (2559/3613) 4 Figure D 1% (46/3613) 5 Figure E 5% (189/3613) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (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: A B C D E Type & Select Correct Answer 1 Application of a knee immobilizer, splinting of the ankle and forearm 1% (24/1709) 2 External fixation of the femur and tibial plateau, splinting of the ankle and forearm 86% (1464/1709) 3 Retrograde intramedullary nailing of the femur, limited internal fixation of the tibial plateau, splinting of the ankle and forearm 7% (117/1709) 4 External fixation of the femur, ORIF of the tibial plateau, splinting of the ankle and forearm 1% (18/1709) 5 Retrograde intramedullary nailing of the femur, ORIF of the tibial plateau, ORIF of the ankle and forearm 4% (74/1709) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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: A Type & Select Correct Answer 1 Definitive external fixation 0% (4/2338) 2 Temporary external fixation then lateral percutaneous screws 2% (39/2338) 3 Lateral nonlocking plate +/- bone graft substitutes 88% (2048/2338) 4 Medial and lateral locking plate +/- bone graft substitutes 3% (73/2338) 5 Lateral percutaneous screws with assisted arthroscopy 7% (156/2338) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (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: A B C D Type & Select Correct Answer 1 Lateral precontoured locked plating 1% (57/4862) 2 Posterior buttress plating 64% (3118/4862) 3 Medial antiglide plating 13% (611/4862) 4 Anterolateral and posteromedial plating 20% (962/4862) 5 Posterolateral neutralization plating 1% (66/4862) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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: A Type & Select Correct Answer 1 Joint depression of 3mm 36% (1806/4961) 2 Ipsilateral femoral shaft fracture 1% (39/4961) 3 Joint widening of 6mm 48% (2399/4961) 4 Ipsilateral tibial shaft fracture 1% (31/4961) 5 Displaced tibial spine fracture 13% (661/4961) L 5 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (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: A B C D E F Type & Select Correct Answer 1 Figure B 4% (101/2416) 2 Figure C 52% (1246/2416) 3 Figure D 26% (618/2416) 4 Figure E 4% (107/2416) 5 Figure F 14% (327/2416) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (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: A Type & Select Correct Answer 1 Spanning knee external fixation 1% (49/3810) 2 Lateral plateau locking plate 1% (54/3810) 3 Posteromedial locking plate 1% (35/3810) 4 Lateral plateau percutaneous lag screws and posteromedial plate 4% (157/3810) 5 Lateral plateau and posteromedial plating 92% (3492/3810) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.212) Which of the following tibial plateau fractures would be most appropriately treated by buttress plating alone? QID: 3635 FIGURES: A B C D E Type & Select Correct Answer 1 Figure A 0% (8/2105) 2 Figure B 2% (51/2105) 3 Figure C 1% (12/2105) 4 Figure D 94% (1976/2105) 5 Figure E 2% (45/2105) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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: A Type & Select Correct Answer 1 Gentle compressive loading of the affected joint through early range of motion exercises 92% (3076/3353) 2 Strict joint immobilzation for three weeks 3% (117/3353) 3 Shear loading of the affected joint 1% (33/3353) 4 Joint distraction with a spanning external fixator for three weeks 3% (94/3353) 5 Glucosamine chondroitin sulfate supplementation 1% (19/3353) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (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: A B C D Type & Select Correct Answer 1 Spanning external fixation 0% (9/2119) 2 Lateral locking plate 2% (51/2119) 3 Lateral buttress plate 3% (62/2119) 4 Posteromedial buttress plate 93% (1974/2119) 5 Medial bridging plate 1% (18/2119) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (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 thru C. What is the most appropriate surgical plan based on the images provided? QID: 3246 FIGURES: A B C Type & Select Correct Answer 1 ORIF with medial and lateral plating with grafting of metaphyseal defect 1% (12/820) 2 ORIF with lateral plating with grafting of metaphyseal defect 91% (746/820) 3 ORIF with medial plating 0% (3/820) 4 ORIF with lateral plating 5% (40/820) 5 Percutaneous articular fragment reduction and screw fixation 2% (13/820) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ10.65) Vascular complications are most commonly seen with which of the following fractures about the knee? QID: 3152 FIGURES: A B C D E Type & Select Correct Answer 1 Figure A 0% (11/2913) 2 Figure B 70% (2038/2913) 3 Figure C 2% (49/2913) 4 Figure D 2% (53/2913) 5 Figure E 26% (752/2913) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ10.176) Lipohemarthrosis of the knee is most likely secondary to which of the following? QID: 3269 Type & Select Correct Answer 1 Seronegative monoarticular arthritis 1% (8/1099) 2 Patellar tendon rupture 3% (29/1099) 3 Medial meniscus tear 4% (39/1099) 4 Medial patellofemoral ligament rupture 3% (30/1099) 5 Occult fracture 90% (989/1099) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (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: A Type & Select Correct Answer 1 Postoperative joint stepoff 39% (904/2339) 2 Alteration of limb mechanical axis 57% (1340/2339) 3 Fracture type 3% (61/2339) 4 Male sex 0% (6/2339) 5 Age greater than 50 1% (20/2339) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (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: A B Type & Select Correct Answer 1 Association with posteromedial corner of the knee injury 10% (70/690) 2 Association with anterior tibial artery injury 10% (70/690) 3 Possible need for dual plate fixation 77% (530/690) 4 Possible need for single extensile anterior approach to the knee 1% (6/690) 5 Increased risk of deep venous thrombosis 2% (12/690) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (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: A B C Type & Select Correct Answer 1 Anatomic lateral locking plate 2% (36/2355) 2 Posteromedial and lateral plates 78% (1827/2355) 3 Anatomic medial locking plate 7% (163/2355) 4 Conversion of the spanning external fixator to a hinged external fixator 0% (6/2355) 5 Posterior buttress plate 13% (317/2355) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ09.182) In an uninjured proximal tibia which statement best describes the shape and position of the medial tibial plateau relative to the lateral tibial plateau? QID: 2995 Type & Select Correct Answer 1 More concave and more proximal 12% (105/870) 2 More convex and more proximal 4% (39/870) 3 More concave and more distal 79% (687/870) 4 More convex and more distal 3% (29/870) 5 Symetric in conture and more distal 0% (4/870) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ09.128) 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? QID: 2941 Type & Select Correct Answer 1 Crushed cancellous allograft 10% (152/1557) 2 Hydroxyapatite 4% (65/1557) 3 Calcium phosphate cement 73% (1144/1557) 4 Autogenous iliac crest 10% (160/1557) 5 Bisected diaphyseal humeral allograft 2% (31/1557) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ09.245) Buttress plating is most appropriate in which of the following clinical situations? QID: 3058 FIGURES: A B C D E Type & Select Correct Answer 1 Figure A 0% (2/729) 2 Figure B 1% (9/729) 3 Figure C 96% (697/729) 4 Figure D 1% (10/729) 5 Figure E 1% (8/729) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.70) 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? QID: 456 FIGURES: A Type & Select Correct Answer 1 Anterior cruciate ligament midsubstance tear 5% (75/1625) 2 Horizontal cleavage lateral meniscus tear 9% (140/1625) 3 Peripheral lateral meniscus tear 73% (1186/1625) 4 Lateral collateral ligament and popliteofibular ligament tear 3% (55/1625) 5 Lateral meniscus posterior root avulsion 10% (166/1625) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ08.51) Based on the following radiographs of tibial plateau fractures, which one is most likely to have a concomitant medial meniscus tear? QID: 437 FIGURES: A B C D E Type & Select Correct Answer 1 A 1% (22/2132) 2 B 3% (54/2132) 3 C 1% (15/2132) 4 D 86% (1844/2132) 5 E 9% (184/2132) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ08.14) 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? QID: 400 FIGURES: A Type & Select Correct Answer 1 Calcium phosphate 65% (519/796) 2 Tricalcium phosphate 21% (169/796) 3 Cancellous autograft 9% (75/796) 4 Cancellous allograft 4% (28/796) 5 rhBMP-7 1% (4/796) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ06.245) 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? QID: 256 FIGURES: A Type & Select Correct Answer 1 Medial and lateral plate fixation through two approaches 83% (636/767) 2 Medial and lateral plate fixation through a single anterior approach 2% (14/767) 3 Lateral locking plate fixation 1% (8/767) 4 Continued external fixation until union 4% (34/767) 5 Multiplanar transarticular external fixator 10% (75/767) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ05.118) 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? QID: 1004 FIGURES: A Type & Select Correct Answer 1 Bulky compressive splint 2% (44/2098) 2 Open reduction and internal fixation 6% (132/2098) 3 Closed intramedullary nailing 2% (46/2098) 4 Spanning external fixation 86% (1805/2098) 5 Hinged spanning external fixation 3% (68/2098) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ05.14) 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? QID: 51 FIGURES: A B Type & Select Correct Answer 1 Cancellous allograft bone chips 7% (44/642) 2 Autograft iliac crest 16% (104/642) 3 Femoral intramedullary reamings 3% (21/642) 4 Calcium phosphate cement 67% (431/642) 5 Calcium sulfate cement 6% (39/642) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ05.113) A 69-year-old female sustains the injuries seen in Figures A and B. This injury is best classified as which of the following? QID: 999 FIGURES: A B Type & Select Correct Answer 1 Schatzker type I tibial plateau fracture 3% (43/1256) 2 Schatzker type III tibial plateau fracture 93% (1171/1256) 3 Schatzker type IV tibial plateau fracture 2% (25/1256) 4 Schatzker type V tibial plateau fracture 1% (10/1256) 5 Schatzker type VI tibial plateau fracture 0% (6/1256) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ04.88) 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? QID: 1193 FIGURES: A B C D E Type & Select Correct Answer 1 Restoration of joint stability 62% (871/1415) 2 Repair of associated meniscal pathology 3% (40/1415) 3 Surgical fixation within 48 hours of injury 0% (7/1415) 4 Correction of the articular depression 27% (384/1415) 5 Tibial condylar diastasis < 3 mm 7% (106/1415) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic
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