Tibial plateau fracture differential diagnosis: Difference between revisions

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{{Tibial plateau fracture}}
{{Tibial plateau fracture}}
{{CMG}}; {{AE}} {{Rohan}}
{{CMG}}; {{AE}} {{Rohan}}


==Overview==
==Overview==
Tibial plateau fracture must be differentiated from [[wrist strain]], [[Ligamentous laxity|ligamentous]] carpal injury such as [[scapholunate]] ligament and [[triangular fibrocartilage]] complex (TFCC) tear.
Tibial plateau fracture must be differentiated from other causes of acute [[knee]] pain, [[restriction of movements]], and [[deformity]] such as [[patella fracture]], [[Patella|patella dislocation]], [[knee dislocation]], [[Ligamentous laxity|ligamentous]] injury such as [[anterior cruciate ligament]], [[posterior cruciate ligament]], [[collateral]] ligaments and [[Tear of meniscus|meniscal]] injury
 
==Differentiating Tibial Plateau Fracture from other Diseases==
* Tibial plateau fracture must be differentiated from other causes of acute [[knee]] pain, [[restriction of movements]], and [[deformity]] such as [[patella fracture]], [[Dislocated patella|patella dislocation]], [[knee dislocation]], [[Ligamentous laxity|ligamentous]]  injury such as [[anterior cruciate ligament]], [[posterior cruciate ligament]], [[collateral]] ligaments and [[Tear of meniscus|meniscal injury]].<ref name="pmid24994048">{{cite journal| author=Karrasch C, Gallo RA| title=The acutely injured knee. | journal=Med Clin North Am | year= 2014 | volume= 98 | issue= 4 | pages= 719-36, xi | pmid=24994048 | doi=10.1016/j.mcna.2014.03.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24994048  }} </ref><ref>{{cite book | last = Rockwood | first = Charles | title = Rockwood and Green's fractures in adults | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia, PA | year = 2010 | isbn = 9781605476773 }}</ref><ref>{{cite book | last = Azar | first = Frederick | title = Campbell's operative orthopaedics | publisher = Elsevier | location = Philadelphia, PA | year = 2017 | isbn = 9780323374620 }}</ref><ref name="pmid7605307">{{cite journal| author=Arnold MH| title=Fractures of the tibial plateau in the elderly as a cause of immobility. | journal=Aust N Z J Med | year= 1995 | volume= 25 | issue= 2 | pages= 178 | pmid=7605307 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7605307  }} </ref><ref name="pmid28131634">{{cite journal| author=Aurich M, Koenig V, Hofmann G| title=Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review. | journal=Asian J Surg | year= 2018 | volume= 41 | issue= 2 | pages= 99-105 | pmid=28131634 | doi=10.1016/j.asjsur.2016.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28131634  }} </ref>


==Differentiating Distal Radius Fracture from other Diseases==
* Tibial plateau fracture must be differentiated from other diseases that [[wrist pain]], [[restriction of movements]], and [[deformity]], such as [[wrist strain]], [[Ligamentous laxity|ligamentous]] carpal injury such as [[scapholunate ligament]] and [[triangular fibrocartilage]] complex (TFCC) tear.
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* Fracture fragment displacement
* [[Fracture]] fragment displacement
* Fracture fragment angulation
* [[Fracture]] fragment angulation
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* Accurate diagnosis of fracture pattern ans aids in classification
* Accurate diagnosis of [[Fracture|fractur]]<nowiki/>e pattern ans aids in [[classification]].
* Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.
* Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.
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* Useful in diagnosing occult [[Bone fracture|fractures]], [[Ligamentous laxity|ligamentous]] and [[soft tissue]] injuries
* Useful in diagnosing occult [[Bone fracture|fractures]], [[Ligamentous laxity|ligamentous]] and [[soft tissue]] injuries
| style="background: #F5F5F5; padding: 5px;" |CT
| style="background: #F5F5F5; padding: 5px;" |[[CT]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Segond Fracture
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Segond [[Fracture]]
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* Evidence of [[Bone fracture|fracture]] on radiographs is usually seen
* Evidence of [[Bone fracture|fracture]] on [[Radiograph|radiographs]] is usually seen
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* Evidence of [[Bone fracture|fracture]] on CT scan is usually seen
* Evidence of [[Bone fracture|fracture]] on [[CT]] scan is usually seen.
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* [[Soft tissue]] swelling and tear of the anterior cruciate ligament (ACL) accompanying the fracture is seen
* [[Soft tissue]] swelling and tear of the [[anterior cruciate ligament]] (ACL) accompanying the [[fracture]] is seen
| style="background: #F5F5F5; padding: 5px;" |MRI
| style="background: #F5F5F5; padding: 5px;" |[[MRI scan|MRI]]
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* It is pathgnomic of  ACL tear
* It is pathgnomic of  [[Anterior cruciate ligament|ACL]] tear
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Patella Fracture
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patella fracture|Patella Fracture]]
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* Fracture fragment displacement
* [[Fracture]] fragment displacement
* Fracture fragment angulation
* [[Fracture]] fragment angulation
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* CT confirms the x-ray finding
* [[CT]] confirms the [[x-ray]] finding.
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* Swelling and tear of the patellar tendon and the retinaculum may be seen
* [[Swelling]] and [[tear]] of the [[patellar tendon]] and the [[retinaculum]] may be seen
* Also helps to identify osteochondral fragments
* Also helps to identify osteochondral fragments
| style="background: #F5F5F5; padding: 5px;" |X-ray
| style="background: #F5F5F5; padding: 5px;" |[[X-ray]]
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* Inability to do straight leg raising test.
* Inability to do [[Straight leg raise|straight leg raising]] test.
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Tibial tuberosity avulsion fracture
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tuberosity of the tibia|Tibial tuberosity]] [[avulsion fracture]]
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* Tuberosity avulsion and displacement is seen
* [[Tubercle (anatomy)|Tuberosity avulsion]] and displacement is seen
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* CT confirms the x-ray finding
* [[CT]] confirms the [[x-ray]] finding
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* Helps to identify accompanying patellar tendon injury
* Helps to identify accompanying [[Patellar tendon rupture|patellar tendon injury]]
| style="background: #F5F5F5; padding: 5px;" |X-ray
| style="background: #F5F5F5; padding: 5px;" |[[X-ray]]
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* Inability to do straight leg raising test.
* Inability to do [[Straight leg raise|straight leg raising]] test.
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|Patella dislocation
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Dislocated patella|Patellar dislocation]]
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* [[Dislocated patella|Disclocated patella]]
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* [[Subluxation|Subluxated]] [[patella]]
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* Associated [[fractures]]
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* [[CT]] confirms [[x-ray]] findings
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* Identifies damage to medial patellofemoral ligament.
* Identifies damage to retinacular ligament and orientation of the surrounding muscles
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]]
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* Apprehension Test positive
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|Knee Dislocation
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Knee dislocation|Knee Dislocation]]
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
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* Type of [[knee dislocation]]
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* Associated [[fractures]]
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* [[CT]] confirms the [[x-ray]]  findings and shows any osteochondral injury
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* [[MRI]] shows damage to internal structures such as [[muscles]], [[ligaments]] and [[Neurovascular bundle|neurovascular]] bundle.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]]
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* [[Angiography]] of the [[lower limb]] is mandatory to check [[blood flow]] to the [[lower limb]] and decrease the chances of [[Vascular injury|vascular insult]]
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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Restriction of Movements
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Restriction of Movements
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
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|Meniscus Injury
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meniscus injuries|Meniscus Injury]]
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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* Normal
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* Normal
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* It helps identify the type of tear and classify the [[tear]].
* It also aids in management plan for [[Tear of meniscus|meniscal injury]].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI scan|MRI]]
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* [[McMurray's test|McMurray's est]] positive for [[Tear of meniscus|meniscal injury]]
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|Ligament Injuries (ACL, PCL, MCL, LCL)
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ligament]] Injuries ([[ACL]], [[PCL]], [[MCL]], [[Lateral collateral ligament|LCL]])
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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* Usually Normal
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* It may show associated avulsion [[Bone fracture|fracture]]
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* Normal
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* It helps to identify partial or complete [[tear]]
* It also aids in distinguishing acute versus chronic [[tears]]
* It may show signs of early [[degeneration]] and [[Cartilage injuries|cartilage wear]] due  to [[ligament]] injury
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]]
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* [[Lachman test]] and [[Drawer test|Anterior Drawer test]] positive in [[Anterior cruciate ligament injury|Anterior cruciate ligament tear]] (ACL)
* [[Posterior drawer test]] and Dial test positive for [[posterior cruciate ligament]] (PCL)
* [[Valgus]] stress test is positive for [[MCL|Medial Collateral Ligament]] (MCL)
* [[Varus]] stress test is positive for [[Lateral collateral ligament|Lateral Collateral Ligament]] (LCL)
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|Quadriceps Tendon Rupture
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Quadriceps tendon rupture|Quadriceps Tendon Rupture]]
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* Usually Normal
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* It may show associated avulsion [[fracture]]
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* Normal
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* It shows degree of [[tear]]
* It also aids in [[Surgery|surgical]] planning
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]]
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* Defect present superior to superior pole of [[patella]]
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|Osgood - Schlatter Disease
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Osgood-Schlatter disease|Osgood - Schlatter Disease]]
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* [[Bone fracture|Fracture]] of [[Tuberosity of the tibia|tibial tuberosity]] apophysis is seen
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* [[CT]] confirms [[x-ray]] findings
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* [[Swelling]] and effusion of the [[Joint (anatomy)|joint]] may be seen
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[X-ray]]
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* [[Adolescent|Adolescents]] are commonly affected by the disease.
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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Peripheral Vascular Injuries]]
style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Restriction of Movements
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Deformity
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Integrity of extensor mechanism
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Distal Pulses
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray
* Normal
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
* Normal
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
* Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Doppler ultrasound]]
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* [[Doppler ultrasound]] and [[angiography]] of the [[lower limb]] confirms the [[disease]]
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|Peripheral Vascular Injuries
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Maisonneuve fracture|Maisonneuve Fracture]]
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* [[Bone fracture|Fracture]] fragment displacement
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* [[Bone fracture|Fracture]] fragment angulation
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[CT]] confirms [[x-ray]] findings
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* Useful in diagnosing occult [[Bone fracture|fractures]], [[Ligamentous laxity|ligamentous]] and [[soft tissue]] injuries
|Maisonneuve fracture
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* [[Foot drop]] may be present in few patients
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* [[Electromyography]] and [[Nerve conduction study|Nerve conduction studies]] done to check for any damage to [[Common fibular nerve|commom peroneal nerve]]
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[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Orthopedic surgery]]
[[Category:Orthopedic surgery]]
[[Category:Primary care]]
[[Category:Fractures]]
[[Category:Fractures]]
[[Category:Bone fractures]]
[[Category:Bone fractures]]

Latest revision as of 00:25, 30 July 2020

Tibial plateau fracture Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tibial plateau fracture from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

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Laboratory Findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Tibial plateau fracture must be differentiated from other causes of acute knee pain, restriction of movements, and deformity such as patella fracture, patella dislocation, knee dislocation, ligamentous injury such as anterior cruciate ligament, posterior cruciate ligament, collateral ligaments and meniscal injury

Differentiating Tibial Plateau Fracture from other Diseases

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Imaging
Pain Restriction of Movements Deformity Tenderness Integrity of extensor mechanism Distal Pulses X-ray CT scan MRI
Tibial plateau fracture + + +/- + + +/-
  • Accurate diagnosis of fracture pattern ans aids in classification.
  • Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.
CT
Segond Fracture + + - + + + MRI
  • It is pathgnomic of ACL tear
Patella Fracture + + + + - + X-ray
Tibial tuberosity avulsion fracture + + + + - + X-ray
Patellar dislocation + + + + +/- +
  • Identifies damage to medial patellofemoral ligament.
  • Identifies damage to retinacular ligament and orientation of the surrounding muscles
MRI
  • Apprehension Test positive
Knee Dislocation + + + + +/- +/-
  • CT confirms the x-ray findings and shows any osteochondral injury
MRI
Diseases Pain Restriction of Movements Deformity Tenderness Integrity of extensor mechanism Distal Pulses X-ray CT scan MRI Gold standard Additional findings
Meniscus Injury + +/- - +/- + +
  • Normal
  • Normal
  • It helps identify the type of tear and classify the tear.
  • It also aids in management plan for meniscal injury.
MRI
Ligament Injuries (ACL, PCL, MCL, LCL) + +/- - + + +
  • Usually Normal
  • It may show associated avulsion fracture
  • Normal
MRI
Quadriceps Tendon Rupture + + + + - +
  • Usually Normal
  • It may show associated avulsion fracture
  • Normal
MRI
  • Defect present superior to superior pole of patella
Osgood - Schlatter Disease + + - + + + X-ray
Peripheral Vascular Injuries + - - + + -
  • Normal
  • Normal
  • Normal
Doppler ultrasound
Maisonneuve Fracture + + + + + + CT confirms x-ray findings X-ray

References

  1. Karrasch C, Gallo RA (2014). "The acutely injured knee". Med Clin North Am. 98 (4): 719–36, xi. doi:10.1016/j.mcna.2014.03.002. PMID 24994048.
  2. Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
  3. Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
  4. Arnold MH (1995). "Fractures of the tibial plateau in the elderly as a cause of immobility". Aust N Z J Med. 25 (2): 178. PMID 7605307.
  5. Aurich M, Koenig V, Hofmann G (2018). "Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review". Asian J Surg. 41 (2): 99–105. doi:10.1016/j.asjsur.2016.11.011. PMID 28131634.

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