Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Acknowledgements
- Part 1 Shoulder girdle
- Part 2 Upper extremity
- Part 3 Pelvis and acetabulum
- Part 4 Lower extremity
- 10 Section I: Extracapsular fractures of the hip
- 11 Section I: Fractures of the femoral shaft
- 12 Fractures of the patella
- 13 Section I: Fractures of the proximal tibia
- 14 Fractures of the ankle
- 15 Fractures of the foot
- Part 5 Spine
- Part 6 Tendon injuries
- Part 7 Compartments
- Index
13 - Section I: Fractures of the proximal tibia
Published online by Cambridge University Press: 05 February 2014
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Acknowledgements
- Part 1 Shoulder girdle
- Part 2 Upper extremity
- Part 3 Pelvis and acetabulum
- Part 4 Lower extremity
- 10 Section I: Extracapsular fractures of the hip
- 11 Section I: Fractures of the femoral shaft
- 12 Fractures of the patella
- 13 Section I: Fractures of the proximal tibia
- 14 Fractures of the ankle
- 15 Fractures of the foot
- Part 5 Spine
- Part 6 Tendon injuries
- Part 7 Compartments
- Index
Summary
Indications
Displaced (> 2 cm) fractures.
Joint depression (usually > 3 cm).
Open fractures.
Fractures with neurovascular compromise.
Fractures with concomitant compartment syndrome.
Knee instability (valgus instability is an indication for surgery, but beware of the presence of pseudolaxity).
Preoperative planning
Clinical assessment
In high-energy injuries, the patient should be initially evaluated and managed according to the ATLS protocol.
The neurovascular status should be thoroughly evaluated and documented.
Evaluate the leg compartments, for disproportionate pain in stretching, undue tension (compartment syndrome).
Check for knee effusion (haemarthrosis).
Evaluate the swelling of the proximal tibia. Repeat the examination at regular intervals.
The stability of the knee is very difficult to assess preoperatively. Usually the knee is in valgus position.
Radiological assessment
Anteroposterior, lateral and oblique views of the knee. Assess the degree of displacement and depression.
The pure lateral tibial plateau fractures are classiied as Schatzker I (split), II (split–depression) or III (depression) (Fig. 13.1.1).
A CT scan is the modality of choice for detecting occult fractures and for preoperative planning (Fig. 13.1.2). When a spanning external fixator is applied for sot tissue resuscitation or neurovascular repair, the CT scan follows the application of the ex-ix, which exerts ligamentotaxis and allows for better delineation of fracture lines and fragments.
An MRI is not usually performed in pure lateral tibial plateau fractures.
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- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 331 - 345Publisher: Cambridge University PressPrint publication year: 2014