Tibial Plateau Fractures
Often called "Bumper Fractures" (car bumper hitting pedestrian's knee), these are intra-articular fractures of the proximal tibia. They often involve depression of the joint surface and ligament/meniscal injury.
1. Schatzker Classification
- Type I: Lateral Split (Wedge). Common in young.
- Type II: Lateral Split + Depression. Most common overall.
- Type III: Pure Depression (Lateral). Common in elderly/osteoporotic.
- Type IV: Medial Condyle Fracture. High energy. Associated with neurovascular injury.
- Type V: Bicondylar Fracture.
- Type VI: Bicondylar + Shaft dissociation.
2. Management
- Goal: Restore articular congruity (< 2mm step-off).
- Surgery: Buttress Plate (Lateral or Medial) + Bone grafting (for depression).
- External Fixation: Used for high-energy Types V/VI with severe soft tissue swelling (to prevent blistering/infection).
3. Physiotherapy
- CPM: Continuous Passive Motion started early to polish the cartilage.
- Weight Bearing: Restricted for 8-12 weeks to prevent collapse of the elevated fragment.
25 Practice MCQs
Q1. Which plateau is more commonly fractured?
Answer: A). Due to valgus force (bumper strike) and weaker trabecular bone.
Q2. Schatzker Type II involves:
Answer: A). Most common type.
Q3. Type IV (Medial Condyle) fracture is dangerous because:
Answer: A). Requires high energy varus force.
Q4. Which structure is often injured alongside lateral plateau fractures?
Answer: A). Meniscus can get trapped in the fracture.
Q5. Acceptable articular step-off is generally:
Answer: A). >2mm leads to arthritis.
Q6. Bone graft is used to:
Answer: A). Prevents re-collapse.
Q7. "Bumper Fracture" usually refers to:
Answer: A). Mechanism of injury.
Q8. Non-weight bearing is typically maintained for:
Answer: A). To allow the depressed fragment to consolidate.
Q9. Which complication is high risk in high-energy plateau fractures?
Answer: A). Bleeding into the calf compartments.
Q10. Schatzker Type VI is:
Answer: A). The joint is floating from the shaft.
Q11. Buttress plate is placed on which side for Type II?
Answer: A). To prevent the lateral fragment from sliding out.
Q12. Arthroscopy assisted fixation allows:
Answer: A). Minimally invasive (MIPPO).
Q13. Segond Fracture is avulsion of:
Answer: A). Often seen with plateau injuries.
Q14. Blisters (fracture blisters) delay surgery because:
Answer: A). Must wait for re-epithelialization (Wrinkle sign).
Q15. Early knee ROM is encouraged to:
Answer: A). Salter's principle of cartilage healing.
Q16. Varus/Valgus instability suggests:
Answer: A). If bone is fixed, laxity = ligament.
Q17. Lipohemarthrosis is:
Answer: A). Indicates intra-articular fracture.
Q18. External Fixation (Ilizarov/Hybrid) is best for:
Answer: A). Spanning the knee allows soft tissue to heal.
Q19. Post-traumatic arthritis is likely if:
Answer: A). Uneven surface wears out cartilage.
Q20. Hinged Knee Brace allows:
Answer: A). Standard post-op brace.
Q21. Most common nerve injury is:
Answer: A). Wraps around fibula neck (near plateau).
Q22. Which view is needed to see depression clearly?
Answer: C). Essential for pre-op planning.
Q23. Bicondylar fractures often result in:
Answer: A). Need dual plating or Ex-Fix.
Q24. Schatzker I is usually treated with:
Answer: A). To compress the split.
Q25. Tibial plateau slopes:
Answer: A). Must be accounted for during screw placement.
No comments:
Post a Comment