CLOSED FRACTURE OF LEFT TIBIAL

PLATEAU SCHATZKER VI

Presented By:
Anneke Holly C111 09 004
Advisors:
dr. Hendra Hermanto
dr. Shandy Limansyahputra
Supervisor:
dr. Zulfan Oktasatria Siregar, Sp.OT
ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT
MEDICAL FACULTY
HASANUDDIN UNIVERSITY
2014

PATIENTS IDENTITY
Name

: Mr. KT

Age

: 43 years old

Admitted

: April 10th 2014

Registratio : 658646
n

AUTOANAMNESIS

Chief Complain : pain at left leg

Suffered since 5 hours before admitted to Dr. Wahidin
Sudirohusodo hospital.
Patient jumped 2 meters-high out from a ship, and landed with
both his feet stepped on the ground. The patient could stand
for a moment, and then felt pain at his left leg and fell down.
History of unconsciousness (-), vomiting (-)
Prior treatment at Akademis Hospital

PRIMARY SURVEY
Airway
Breathin
g
Circulati
on
Disabilit
y
Exposur
e

: Clear, patent
: RR 20 x/min, symmetric, spontaneous,
thoracoabdominal type.
: BP 120/70 mm/Hg, HR 88x/min, regular,
strong
: GCS 15 E4V5M6, pupil isochor, diameter
2.5mm/2.5mm, light reflex (+/+)
: 36.7 C (axillary)

SECONDARY SURVEY
Left Leg Region
Look

: Deformity (+), swelling (+), hematoma (-), wound (-),

shiny skin (-)

Feel

: Tenderness (+), NVD: sensibility is good, dorsalis pedis

artery and tibialis posterior artery are palpable, CRT
<2
Pain on passive stretching (-)

Move

: Active and passive motions of knee joint are not

evaluated.
Right of ankle
Left
Active and passive motions
joint are normal.
ALL

81 cm

81 cm

TLL

71 cm

71 cm

LLD

0 cm

Clinical Presentation of Anterior View of Left Leg

Clinical Presentation of Lateral View of Left Leg

RADIOLOGY FINDINGS
(From Akademis Hospital)

RADIOLOGY FINDINGS

LABORATORY FINDINGS

RBC : 4,15 x 103/mm3

HGB : 12,8 g/dL
HCT : 38,6 %
WBC : 16,7 x 103/mm3
PLT : 270 x 103/mm3
CT
: 800
BT
: 300

GDS
: 102 mg/dL
Ureum
: 22 mg/dL
Creatinine
: 1.0 mg/dL
GOT
: 29 U/l
GPT
: 44 U/l
Na
: 142 mmol/L
K
: 3.9 mmol/L
Cl
: 110 mmol/L
HbsAg
: Non-reactive

RESUME
Man, 43 years old, admitted to Dr. Wahidin Sudirohusodo
Hospital with chief complain pain at left leg since 5 hours. Prior
treatment at Akademis Hospital. Mechanism of trauma is the patient
jumped 2 meters-high out from a ship, and landed with both his feet
stepped on the ground. The patient could stand for a moment, and
then felt pain at his left leg and fell down.
Physical Examination, on left leg region there is deformity (+),
swelling (+), tenderness (+), NVD: sensibility is good, dorsalis pedis
artery and tibialis posterior artery are palpable, CRT <2, active and
passive motions of knee joint are not evaluated due to pain, active
and passive motions of ankle joint are normal.
Radiology findings from X-Ray of anterior and lateral view of
Left Leg is fracture at left tibial plateau.

DIAGNOSIS

MANAGEMENT

IVFD
Analgesic
Apply long leg back slab at left lower extremity
Plan for ORIF

CLOSED FRACTURE OF
LEFT TIBIAL PLATEAU
DISCUSSION

INTRODUCTION
The tibial plateau is the proximal weightbearing surface of the
tibia.
It is articulated with the femoral condyles to form the knee
joint and can be divided into medial and lateral components.
A tibial plateau fracture involving the proximal articular
surface of the tibia.
Schatzker divided the classifications into 6 types,.
Neurovascular injury and compartment syndrome may occur

Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7

EPIDEMIOLOGY
1% of all fractures and 8% of fractures in eldery persons.
Isolated medial plateau fractures about 10-23% of these
injuries
Isolated lateral plateau fractures about 55-70% of these
injuries
The combined medial and lateral plateau fractures about
11-31% of these injuries.

Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7

ANATOMY

Thompson JC. Leg and Knee. Netter Concise Orthopaedic Anatomy. 2nd ed. Saunders Elsevier. p. 286-322.

Thompson JC. Leg and Knee. Netter Concise Orthopaedic Anatomy. 2nd ed. Saunders Elsevier. p. 286-322.

www.eorthopod.com

Thompson JC. Leg and Knee. Netter Concise Orthopaedic Anatomy. 2nd ed. Saunders Elsevier. p. 286-322.

ETHIOPATHOMECHANISM
Fractures of the tibial plateau are caused by a
varus or valgus force combined with axial
loading.
This is sometimes the result of a car striking a
pedestrian (bumper fracture)
More often it is due to a fall from a height in
which the knee is forced into valgus or varus.

Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7

Associated Injury:
Cranial Injury
Thoracic Injury
Abdominal Injury
Spinal Injury
Pelvic Injury
Skeletal Injury
Soft tissue injury

CLINICAL PRESENTATION

Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7

Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7

SCHATZER CLASSIFICATION

Type 1

Type 2

Type 3

Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
Arnold; 2010. p. 890-5

Type 4

Type 5

Type 6

Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
Arnold; 2010. p. 890-5

DIAGNOSTIC TEST
Radiography:
Used to identify the fracture
lines and estimate displacement
Oblique radiographs may be
helpful in assessing fracture
lines.

Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
Arnold; 2010. p. 890-5

 CT:
Obtain scout views to ensure the
images are tangent to the
articular surface.
Helps plan surgery and assess
the articular surface of the joint

Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
Arnold; 2010. p. 890-5

 MRI:
Useful in identifying soft-tissue injury, including
ligamentous and meniscal injury
Also useful for diagnosing nondisplaced fractures

Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
Arnold; 2010. p. 890-5

DIAGNOSIS

TREATMENT

Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7
Miller MD, Stephen RT, Jennifer AH. Review of Orthopaedics. 6th ed. Elsevier Saunders. 2012. p. 757-8

Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7
Miller MD, Stephen RT, Jennifer AH. Review of Orthopaedics. 6th ed. Elsevier Saunders. 2012. p. 757-8

Type 1

Type 2

Type 3

Type 4
www.netterimages.com/image/3280

Type 5

Type 6

www.netterimages.com/image/3280

www.eorthopod.com

The postoperative x-ray

shows that perfect
reduction has been
achieved

Significant depression and some lateral

displacement of the lateral condyle; Open
reduction and internal fixation with a
buttress plate

Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
Arnold; 2010. p. 890-5

COMPLICATION

Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
Arnold; 2010. p. 890-5

Thank You