Tibial Plateau Fractures Flashcards

1
Q

Demographics of tibial plat fx

A

Bimodal
Males in 40s = high energy
Females in 70’s = low energy

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2
Q

Order of condyle that is affected

A

Lateral> bicondylar > medial

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3
Q

Mechanism

A

-varus/valgus load with or -without axial load
high energy :frequently associated with soft tissue injuries
-low energy: usually insufficiency fractures

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4
Q

Associated conditions of tib plat fx: (4)

A

Lateral meniscal tears> Medial meniscal tears

ACL injuries
Compartment syndrome
Valscular Injury

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5
Q

Which plateau is convex?

A

Lateral, it is also proximal to the medial plateau.

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6
Q

How much does the medial plateau bear>

A

60%?

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7
Q

How much degrees varus valgus stress test indicates instability?

A

> 10 degrees

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8
Q

What optional view to order?

A

Plateau view (10 degree caudal tilt)

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9
Q

What CT finding indicates an occult fx?

A

LIPOHEMARTHROSIS

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10
Q

When do you use MRI?

A

To determine meniscal and ligamentous pathology

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11
Q

Operative Indications

A
  • articular stepoff > 3mm
  • condylar widening > 5mm
  • varus/valgus instability
  • all medial plateau fxs
  • all bicondylar fxs
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12
Q

What is the strongest predictor of long term outcomes?

A

Restoration of joint stability

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13
Q

Outcomes are worse for tib plat ORIF with what 3 things?

A
  • ligamentous instability
  • meniscectomy
  • alteration of limb mechanical axis > 5 degrees
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14
Q

Ex fix is locked in what position?

A

Locked in SLIGHT FLEXION

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15
Q

How far away do you insert Ex fix pins?

A

> 14 mm from joint

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16
Q

Which ORIF incision should you avoid?

A

Midline, can cause significant soft tissue stripping

17
Q

Posteriomedial incision interval?

A

interval between pes anserinus and medial head of gastrocnemius

18
Q

What type of plates are indicated for healthy bone?

A

Non locked buttress plates

19
Q

Why do early passive ROM in a hinged knee brace?

A

improves chondrocyte survival