3. Primary Survey
• A: Patient can talk, no c-spine tenderness
• B: equal both lung , no adventitious sound
• C: BP 150/76 mmHg, PR 90 /min, no active
bleeding, pulse 2+ all extremities
• D: E4V5M6, pupil 3 mm RTLBE
• E: Rt.knee tenderness and swelling , limit ROM due
to pain
4. Secondary survey
• A : no drug/food allergy
• M : Current medication Amlodipine,
metformin
• P : u/d DM, HT , no previous surgical history
• L : 3 hrs PTA
• E : as in present illness
11. Fracture tibial plateau
Mechanism
• varus/valgus load with or without axial load
• high energy
frequently associated with soft tissue injuries
• low energy
usually insufficiency fractures
16. Physical examination
inspection
• look circumferentially to rule-out an open injury
palpation
• consider compartment syndrome when compartments are firm and
not compressible
• varus/valgus stress testing ,any laxity >10 degrees indicates
instability
often difficult to perform given pain
neurovascular exam
• any differences in pulse exam between extremities should be
further investigated with anke-brachial index measurement
17. Investigation
• Radiographs
– recommended views
• AP, lateral, oblique
– oblique is helpful to determine amount of depression
– optional views
• plateau view
• CT scan
– important to identify articular depression and comminution
– findings
• lipohemarthrosis indicates an occult fracture
• fracture fragment orientation and surgical planning
19. Indication for operative treatment
Fracture not stable : varus,vagus instability
Displaced fracture of medial condyle
Lateral condyle displace > 5 mm, step off> 3 mm
Open fracture
Ipsilateral leg fracture
21. In This Patient
• Observe vascular injury 72 hr
– Admit trauma , observe ABI q 12 hr
– ABI index = 1.0
• Pain control
• PT for ambulation (Non weight bearing) and
strenghtening exercise
• Operative treament : ORIF with P&S
22.
23.
24. Reference
• Rockwood and Green’s fracture in adults. 8th
edition
• http://ortho.md.chula.ac.th/student/tibial-
p.html
• http://www.orthobullets.com/trauma/1044/ti
bial-plateau-fractures
• http://www.bonetalks.com/kneeplateau/