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PATIENTS IDENTITY
Name
Register
: Mrs. M
no. :774350
Sex
: Female
Age
Date
HISTORY
TAKING
Mechanism
of
injury:
patient
was
riding
PRIMARY
SURVEY
Airway
SECONDARY SURVEY
Right Knee Region
Description
LOOK
FEEL
MOVE
NVD
SECONDARY SURVEY
Right leg Region
Description
LOOK
FEEL
Tenderness (+)
MOVE
NVD
Right
Left
Appearance Leg
Length
99cm
99cm
88cm
88cm
Leg Length
Discrepancy
Clinical Photo
Medial View
Anterior View
Lateral View
Radiological Finding
Right Genu X-Ray Ap/Lat
Comminutive
fracture 1/3
proximal right
tibia
Oblique
fracture right
head of fibula
Radiological Finding
Right Cruris X-Ray Ap/Lat
Comminutive
fracture 1/3
proximal right
tibia
Oblique
fracture right
head of fibula
LAB
Lab Finding
WBC
7.5 x 103/uL
4-10 x 103/uL
RBC
3.88 x 106/uL
3.8-5.8 x 106/uL
HB
11.8 gr/dl
12-16 gr/dl
PLT
191x 103/uL
150-400 x 103/uL
Resume
From the secondary surveyat the right knee region: Deformity (+),
Swelling (+), Haematoma (+). Tenderness (+), Patellar Tap (+),
Ballotement (+). Active and passive movement of the knee joint
is limited due to pain. NVD: Sensibility is good, Pulsation of
dorsalis pedis and tibialis posterior arteries are palpable,
Capillary Refill Time 2 seconds.Extend big toe (+).
Secondary survey at the right leg region: Deformity (+), Bulla (+)
diameter 3cm, Shiny Skin (+). Tenderness (+). Active and
passive movement of the knee joint is limited due to pain.
Sensibility is good, Pulsation of dorsalis pedis and tibialis
posterior arteries are palpable, Capillary Refill Time 2
seconds.Extend big toe (+)
From X-ray right cruris AP/Lateral and right genu AP/Lateral found
Comminutive fracture 1/3 proximal right tibia ,Oblique fracture
right head of fibula.
DIAGNOSIS
MANAGEMENT
Early treatment :
IVFD
crystaloid
Analgesic
Observe
Temporary Management
Apply
Definitive treatment :
Internal
fixation (ORIF)
Discussion
Tibial Plateau Fractures
Leg Compartment
Muscle :
Anterior
Compartment
Tibialis anterior
Extensor hallucis
longus
Extensor digitorum
longus
Peroneus tertius
Muscle :
Lateral
Compartment
Peroneus longus
muscle and tendon
Peroneus brevis muscle
and tendon
Muscle :
Superficial
Posterior
Compartment
Gastrocnemius
Soleus
Plantaris
MUSCLES: DEEP
POSTERIOR
COMPARTMENT
Posterior tibialis
Flexor hallucis longus
Flexor digitorum longus
Popliteus
FRACTURE ?
Break in the structural
continuity of bone.
CLOSED
overlying skin
remains intact
OPEN
Solomon, Louis et al. 2010. Apleys System of Orthopaedics and Fractures, 9 th edition. New
TIBIAL PLATEAU
FRACTURES?
Intra-Articular
fractures of
proximal tibia
Knee Joint
Extends
higher
Convex
in both
sagittal
and
coronal
axes
Larger
Concave
in both
sagittal
and
coronal
axes
EPIDEMIOLOGY
Constitute
10%
10%
From
Fractures
common.
Koval, Zuckerman. Handbook of fractures, 3rd edition
SCHATZKER CLASSIFICATION
TYPE
DESCRIPTION
Type 1
Type 2
Type 3
Depression of the
articular surface with an
intact condylar rim.
Robert W, dkk. Rockwood and Greens Fractures in Adult 7th edition. Lippincott: 2010
TYPE
DESCRIPTION
Type 4
Type 5
Fracture of both
condyles.
Type 6
Robert W, dkk. Rockwood and Greens Fractures in Adult 7th edition. Lippincott: 2010
Meniscus tear
Knee ligament
injury
Fracture of
patella
ASSOCIATE
D INJURY
Common
Peroneal nerve
injury
Moore D. Tibia Plateau Fracture. Orthobullets.
Fracture of
fibular head
CLINICAL FEATURES
Look
Feel
Move
NVD
Solomon, Louis et al. 2010. Apleys System of Orthopaedics and Fractures, 9 th edition. New
York : Arnold.
IMAGING
1.
2.
amount of comminution or
plateau depression
2.
3.
th
York : Arnold.
RADIOLOGICAL IMAGING
(a) X-rays provide information about the position of the main fracture
lines and areas of articular surface depression.
(b,c) CT reconstructions reveal the extent and direction of
displacements, vital information for planning the operation.
Solomon, Louis et al. 2010. Apleys System of Orthopaedics and Fractures, 9 th edition. New
York : Arnold.
TREATMENT
NON OPERATIVE
Hinged
Partial
knee brace
weight bearing for 8-12
weeks
Immediate
passive ROM
TREATMENT
Open
OPERATIVE
COMPLICATIONS
Without Treatment
Early
Compartment
syndrome
With Treatment
Late
Joint stiffness
Malunion
Nonunion
Early
Infection
Implant failure
Fat emboli
DVT
Late
Post traumatic
Osteoarthritis
Deformity
(valgus or
varusdeformity)
Post traumatic
Osteoarthritis
Deformity
(valgus or
varusdeformity)
Robert W, dkk. Rockwood and Greens Fractures in Adult 7th edition. Lippincott: 2010
Solomon, Louis et al. 2010. Apleys System of Orthopaedics and Fractures, 9 th edition. New
York : Arnold.
Koval, Zuckerman. Handbook of fractures, 3rd edition
THANK YOU
Grade I
Grade II
Grade III
Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Third Edition. New York: Lippincott Williams &
Wilkins. 2006.
based force
(Bumper fracture as car strikes
outside of persons leg and create a
valgus )
2)pure
3)combination
PRICE
(protection/rest/ice/compression/elevation)