VCOM Carolinas Research Day 2023

Clinical Case-Based Reports

Case Report: Tibial Plateau Fracture Mackenzie Pargeon OMS-III and Lindsay Tjiattas-Saleski DO, MBA, FACOEP Aiken Regional Medical Center, Aiken, SC and Edward Via College of Osteopathic Medicine, Spartanburg, SC.

Abstract # CBR-12

Introduction

Imaging

Discussion

Diagnosis: • X-rays are indicated when a tibial plateau fracture is suspected. 2,5 • CT is indicated if a tibial plateau fracture is suspected but not

• The tibia is the second largest bone in the human body and is an essential weight bearing bone. 1,2 • Tibial plateau fractures are rare and account for less than 2% of all fractures. 2,5 • Typically occur from high energy mechanisms in men in their 40’s and 50’s and in elderly women via low energy mechanisms. 2,5 • The clinical presentation includes: pain, inability to bear weight on the affected leg, swelling, bruising, decreased range of motion and visible deformity. 2,3,5,6 • The physical exam includes: evaluation of the skin to look for an open fracture, evaluation for knee effusion, compartment syndrome, neurovascular compromise, range of motion, and varus/valgus testing. 2,5 • These fractures cause misalignment of articular surfaces and instability of the knee. 2 • If not treated appropriately, they can lead to further instability and loss of functionality of the knee. 2 A 37-year-old female presented to the Emergency Department with left knee pain. The patient was playing catch with her 70-lb St. Bernard when the dog ran back towards her and collided with the side of her knee. The patient fell to the ground and was immediately unable to bear weight on the left leg. The patient denies hearing any pops or clicks. On physical exam, she was noted to have an effusion of the left knee, diffuse tenderness to palpation of the knee and decreased range of motion secondary to pain. AP and lateral X-rays of the left knee were obtained (Figures 1 and 2), which revealed a comminuted fracture of the lateral tibial plateau and a large joint effusion. The patient underwent open reduction with internal fixation the following day. Case

Figure 1. AP X-Ray of Left Knee

visible on X-ray, as these fractures can be occult. 2,5 • CT is also utilized for pre-operative planning. 2,5 Classification 2 :

• Schatzker types I-III include fractures of the lateral plateau. • Treatment involves open reduction with internal fixation or arthroscopically assisted reduction with internal fixation using a lateral approach • Schatzker types IV-VI are treated with open reduction with internal fixation • Type IV uses a posteromedial approach • Types V and VI uses a dual medial and lateral approach • Highly contaminated open fractures and significantly comminuted fractures can be treated with external fixation Management 2 : Non-operative management – placed in knee brace or immobilizer and non-weight bearing for about 8 weeks. • Minimal displacement. • Low energy mechanism with stable ligamentous support. • Non-ambulatory at baseline. • Patient has comorbidities that would prevent them from being surgical candidates.

Figure 2. Lateral X-Ray of Left Knee

References

Acknowledgements

Thank you to the patient for the use of her case and images .

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