Tibial Plateau Fractures Flashcards
Demographics of tibial plat fx
Bimodal
Males in 40s = high energy
Females in 70’s = low energy
Order of condyle that is affected
Lateral> bicondylar > medial
Mechanism
-varus/valgus load with or -without axial load
high energy :frequently associated with soft tissue injuries
-low energy: usually insufficiency fractures
Associated conditions of tib plat fx: (4)
Lateral meniscal tears> Medial meniscal tears
ACL injuries
Compartment syndrome
Valscular Injury
Which plateau is convex?
Lateral, it is also proximal to the medial plateau.
How much does the medial plateau bear>
60%?
How much degrees varus valgus stress test indicates instability?
> 10 degrees
What optional view to order?
Plateau view (10 degree caudal tilt)
What CT finding indicates an occult fx?
LIPOHEMARTHROSIS
When do you use MRI?
To determine meniscal and ligamentous pathology
Operative Indications
- articular stepoff > 3mm
- condylar widening > 5mm
- varus/valgus instability
- all medial plateau fxs
- all bicondylar fxs
What is the strongest predictor of long term outcomes?
Restoration of joint stability
Outcomes are worse for tib plat ORIF with what 3 things?
- ligamentous instability
- meniscectomy
- alteration of limb mechanical axis > 5 degrees
Ex fix is locked in what position?
Locked in SLIGHT FLEXION
How far away do you insert Ex fix pins?
> 14 mm from joint
