Tibial plateau fracture differential diagnosis

Tibial plateau fracture Microchapters
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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 wrist strain, ligamentous carpal injury such as scapholunate ligament and triangular fibrocartilage complex (TFCC) tear.

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 carpal injury such as scapholunate ligament and triangular fibrocartilage complex (TFCC) tear.

Diseases	Clinical manifestations						Para-clinical findings			Gold standard	Additional findings
	Symptoms			Physical examination
							Imaging
	Pain	Restriction of Movements	Deformity	Tenderness	Decreased Grip Strength	Decreased sensation in course of Median nerve	X-ray	CT scan	MRI
Tibial plateau fracture	+	+	+	+	+	+/-	Distal fragment displacement Distal fragment angulation Radial shortening	Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.	Useful in diagnosing occult fractures, ligamentous and soft tissue injuries	X-ray
Segond Fracture	+	+	-	+	-	-	No evidence of fracture on radiographs	No evidence of fracture on CT	Soft tissue swelling and tear may be seen	MRI
Patella Fracture	+	+	+/-	+	-	-	No evidence of fracture on radiographs	No evidence of fracture on CT	Swelling and tear of the ligament may be seen	MRI	Most common injury is scapholunate ligament tear with widening of the scapholunate interval. Positive Watson shift test.
Tibial tuberosity avulsion fracture	+	+/-	-	+	-	-	No evidence of fracture on radiographs	No evidence of fracture on CT	Swelling and tear of the ligament may be seen	MRI	Wrist arthroscopy can be useful in visualizing and repairing TFCC tear
Patella dislocation
Knee Dislocation
Meniscus Injury
Ligament Injuries (ACL, PCL, MCL, LCL)
Quadriceps Tendon Rupture
Osgood - Schlatter Disease
Peripheral Vascular Injuries
Maisonneuve fracture