Water Doctors
Hohly Schat(zker)
Reasonable Reduction
My tibia hurts
From the literature
100
Soft tissue injury most associated with Schatzker II tibial plateau fractures
lateral meniscus tear
100
This Schatzker class signifies poor bone quality.
III, seen in lower energy mechanisms.
100
Most common complication of a mal-reduced tibial plateau fracture?
Post-traumatic arthritis
100
Clinical signs of compartment syndrome?
5 p's:
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
100
How did the study by Vaartjes et al measure fracture gap and articular step-off in tibial plateau fractures?
CT imaging: maximum value of gap/step-off on axial, coronal, or sagittal.
200
Concomitant injuries to the ACL are more common with which plateau fracture patterns/mechanism?
Valgus directed forces, resulting in lateral plateau fracture patterns.
200
This tibial plateau fracture pattern is highest risk of developing compartment syndrome.
Schatzker IV
200
Eponymous name for tibial plateau x-ray view?
Moore view (10-15 degrees caudal tilt)
200
Contents of the deep posterior compartment?
PTT, FHL, FDL, Popliteus, Posterior tibial artery/vein, tibial nerve
200
In the HEVBTP paper by Barei et. al, what 3 "significant associated injuries" were documented in the study?
Popliteal artery injury, peroneal nerve paralysis, compartment syndrome
300
Describe the most common type of lateral meniscus injury seen in tibial plateau fractures in the study by Warner et al
meniscocapsular avulsion
300
The three column theory can be used to better characterize this fracture pattern
posterior shear
300
Normal values of posterior tibial slope?
8-12 degrees of posterior slope
300
What is the quantitative definition of compartment syndrome?
Diastolic BP - Compartment pressure = <30mmHg
300
A study by Gardner et. al found what radiographic measurements on plain films to be significantly associated with soft tissue injury
depression > 6 mm AND widening > 5 mm
400
What pattern of PCL injury is most commonly seen in Schatzker II tibial plateau fractures based on Gardner et al?
Footprint avulsion
400
Isolated medial plateau fracture with a fracture line that exits ___ to the ___ implies a possibly lower energy mechanism
medial; tibial spine
400
What 2 tibial plateau fracture features are associated with a loss of articular reduction postoperatively?
Comminution
Coronal Fracture Orientation (difficult to fix rigidly)
Kim CW, Lee CR, An KC, et al. Predictors of reduction loss in tibial plateau fracture surgery: focusing on posterior coronal fractures. Injury. 2016;47(7):1483–1487.
400
Important vascular exam, how it's performed, and what values indicate further investigation in a tibial plateau fracture
ABI, LE systolic BP/UE systolic BP, <0.9 criterium for CTA
400
Radiographic Hallmarks Of HEVBTP Fracture (4)
1: Sagittal plane malalignment with loss of normal posterior slope
2: Tension failure of posterior cortex
3: compression of the anterior cortex
4: Varus deformity in the coronal plane
500
What percentage of competitive/professional athletes who sustain a tibial plateau fracture return to competitive sport?
22%
Of the professional or competitive athletes (n = 11 at the time of injury), only two returned to competition at the time of the survey.
Kraus TM, Martetschlager F, Muller D, et al. Return to sports activity after tibial plateau fractures: 89 cases with minimum 24-month follow-up. Am J Sports Med. 2012;40(12):2845–2852. PMID: 23118120
500
The Moore classification of this fracture is
III
500
Contrast the results of the paper by Vaartjes et al. to prior accepted plateau fracture step-off values (mm) that can be managed non-operatively.
Previously described arbitrarily as 2mm, this study says 4mm is acceptable.
500
What 3 tibial plateau fracture characteristics make compartment syndrome more likely to occur?
Increased widening of the tibial plateau
Relative displacement of femoral axis compared with the tibial mechanical axis
Higher Schatzker type
Ziran BH, Becher SJ. Radiographic predictors of compartment syndrome in tibial plateau fractures. J Orthop Trauma. 2013;27(11):612–615.
500
List three structural augments that can be used to maintain the PTS after reduction of HEVBTP
tricortical iliac crest, fibular allograft, spine cage