Tibia

Question 1

Tibial Plateau Fracture mechanism

Answer 1

• varus/valgus load ± axial loading (e.g. fall from height)
• femoral condyles driven into proximal tibia
• can result from minor trauma in those with osteoporosis

Question 2

Tibial Plateau Fracture clinical features

Answer 2

• frequency: lateral > bicondylar > medial
• medial fractures require higher energy – often have concomitant vascular injuries
• knee effusion
• inability to bear weight
• swelling
• associated with compartment syndrome, ACL injury, and meniscal tears
• Schatzker classification

Question 3

Tibial Plateau Fracture investigations

Answer 3

• X-ray: AP, lateral, oblique
• CT: pre-operative planning, identify articular depression and comminution
• ABI if any differences in pulses between extremities

Question 4

Tibial Plateau Fracture treatment

Answer 4

Approach #1 - (based on amount of depression seen on x-ray)
Non-operative indication (if depression on x-ray is <3 mm): straight leg immobilization x 4-6 wk with progressive ROM weight bearing
Operative indication (if depression is >3 mm): ORIF often requiring bone grafting to elevate depressed fragment

Approach #2 (based on varus/ valgus instability)
Non-operative indication (if minimal varus/valgus instability [<15°]): straight leg immobilization x 4-6 wk with progressive ROM weight bearing 
Operative indication (if significant varus/valgus instability [>15°]): ORIF often requiring bone grafting to elevate depressed fragment

Question 5

Tibial Plateau Fracture specific complications

Answer 5

• ligamentous injuries
• meniscal lesions
• AVN
• infection
• OA

Question 6

Schatzker Classification

Answer 6

Type I - Involvement of lateral plateau split fracture

II Lateral split-depressed fracture

III Involvement of lateral plateau: pure depression fracture

IV Medial plateau fracture

V Bicondylar plateau fracture

VI Bicondylar with metaphyseal/diaphyseal involvement

Question 7

Most common long bone fracture and open fracture

Answer 7

Tibial shaft fracture

Question 8

Tibial shaft fracture mechanism

Answer 8

• low energy pattern: torsional injury

* high energy: including MVC, falls, sporting injuries

Question 9

Tibial shaft fracture clinical features

Answer 9

• pain, inability to weight bear
• open vs. closed
• neurovascular compromise

Question 10

Tibial shaft fracture investigations

Answer 10

• X-ray: AP lateral

■ full length, plus knee and ankle

Question 11

Tibial shaft fracture treatment

Answer 11

• non-operative
■ indication closed and minimally displaced or adequate closed reduction
◆ long leg cast x 8-12 wk, functional brace after

• operative
■ indication: displaced or open
◆ if displaced and closed: ORIF with IM nail, plate and screws, or external fixator
◆ if open: antibiotics, I&D, external fixation or IM nail, and vascularized coverage of soft tissue defects

Question 12

Tibial shaft fracture specific complications

Answer 12

• high incidence of neurovascular injury and compartment syndrome
• poor soft tissue coverage (critical to outcome)

Tibial shaft fractures have high incidence of compartment syndrome and are often associated with soft tissue injuries

Question 13

Difference between scapular Y and lateral view

Answer 13

same thing