Today on the emDocs cast with Brit Long, MD (@long_brit), Manpreet Singh, MD (@MprizzleER), and Rachel Bridwell, MD (@rebridwell) we cover two posts: tibial plateau fracture and knee dislocation.
Part 1: Tibial Plateau Fracture
Key Points from the Podcast and Post:
- Bimodal distribution: Men < 50 years old more likely to sustain injury via high energy mechanisms; Women > 70 years old more likely to sustain secondary to falls.
- Account for 1% of all fractures and are typically sustained with high-energy mechanisms.
- Patients typically present in discomfort, refusing to bear weight on the affected extremity.
- May have effusion, open soft tissue injury, ligament injury, and neurovascular deficits present. Location: unicondylar vs. bicondylar.2
- Tibial Plateau fractures commonly classified based on Schatzker Classification SystemHigh clinical suspicion of acute compartment syndrome in high energy mechanisms, Schatzker VI fractures, and associated fibular fractures requiring frequent compartment checks.
- At minimum, 4 radiographic views of affected knee are recommended. CT can assist and provides further delineation of fracture.
- Discuss with orthopedics. With the exception of non-displaced or non-depressed fracture without meniscal or ligamentous injury, surgery may be needed.
- Keep compartment syndrome at the forefront of your thoughts during initial assessment and reevaluations.
Part 2: Knee Dislocation
Key Points from the Podcast and Post:
- 2 types of knee dislocations
- Patellofemoral
- Tibiofemoral
- 2 mechanisms: high energy trauma versus low energy. Obesity is a risk factor, and knee dislocations may spontaneously reduce.
- Requires complete disruption of multiple ligaments (ACL, PCL, MCL, LCL). Popliteal artery tethered posteriorly; high risk of vascular injury.
- Presents open vs. closed. Inspect whole extremity. Perform full neurovascular exam.
- If dislocated, reduce! Immediate reduction important, especially with neurovascular deficit present, as >8 hours has been associated with increased rates of amputation.
- Neurovascular exam after reduction. If hard signs present, patient needs OR. All others need CTA (preferred) vs. ABI. ABI < 0.9 needs further evaluation, CTA.
- Admit for serial evaluations with high risk of compartment syndrome.
