9/16/2023 0 Comments Closed fracture tibial plateauIn a study of 103 patients with various Schatzker type fractures, a total of 99% presented associated soft-tissue injuries and 77% a complete anterior cruciate ligament (ACL) or LCL injury, whereas 81% presented with a significant lateral meniscal tear and 44% a medial meniscus tear. 10, 11 The identification of soft-tissue injuries with MRI can change the surgical treatment and/or rehabilitation plan. Articular depression > 6 mm and/or articular widening > 5 mm are associated with the existence of lateral meniscus, lateral collateral ligament (LCL) or posterior cruciate ligament injuries. Intra- and peri-articular soft-tissue structures can be affected even in less complex fracture patterns and some X-ray or CT scan data can also suggest the existence of a lateral or medial meniscal tear. 9 These findings and the wider availability of CT scanning have made the oblique views less important in the diagnosis. But single radiographs do not allow an exact fragment identification and the initial fracture classification can change in 5% to 24% (mean 12%) of cases and treatment can change in up to 26% of cases after CT scan imaging. Traditionally, initial radiograph diagnosis should include anteroposterior (AP), lateral and oblique views. 6 One should be aware of the four ‘p’ rule (pain, pallor, paresthaesia and pain with passive stretch) in the initial phase of treatment to identify this condition and treat it as soon as possible.ĭiagnosis and classification of the fracture Its incidence can rise to 17% of closed and 18.7% of open complex pattern proximal tibia fractures. 8Ĭompartment syndrome can be a devastating complication affecting proximal tibia fractures. According to these reports we should place the external fixator pins in the optimal situation to control the fracture 7 and in a position that does not interfere with the definitive osteosynthesis plan. Even though one recent paper concludes that, with an infection rate of 7.6%, this ‘common fear does not appear to be clinically grounded’, 7 an even more recent paper analysing proximal and distal tibial fractures 8 supports the view that, with an infection rate of 12% in proximal tibia fractures, the risk of infection when there is overlapping is clearly higher. Bars should be configured in two planes, in order to control varus-valgus and flexion-extension forces, and tightened in slight traction to reduce the fracture fragments.Īnalysis of the infection risk of the fracture fixation site after pin site-plate overlap shows controversial results. 1, 6 A common frame consists of two 4.5 to 5.0 mm pins placed anteriorly in the middle third femoral shaft and another two in the middle or distal third of the tibial shaft. Knee-spanning external fixators can be used to approximate the fracture fragments by the process of ligamentotaxis. The use of a staged approach using external fixation is recommended in complex patterns and high-energy trauma, especially in cases of axial instability. 1 Knee immobilisation can be achieved by splinting or by external fixation. Immobilisation of the knee and cryotherapy are the most commonly-used methods to diminish the inflammatory response. Management in the early stages of treatment should focus on preventing further soft-tissue injury while waiting to repair the fracture. 5 Blood-filled blisters should be expected to be associated with a worse outcome than clear fluid-filled ones. 4 This commonly leads to blistering of the skin and in some cases dermal and even muscle necrosis. 3 The oedema and inflammation associated with the trauma can easily lead to local venous compromise, dermal hypoxia, and additional soft-tissue injury. One should think that the fracture will not change but soft tissue will, and therefore, especially in high-energy injuries, fractures should be considered as ‘substantial soft-tissue injuries with a broken bone inside’ ( Fig. Soft-tissue damage in fractures around the knee is of critical importance. What is the state of the soft tissues surrounding the fracture?
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