This document describes a case of a 50-year-old female who presented with left leg deformity and swelling after being involved in a motor vehicle accident where she hit a pole 6 hours prior. On examination, she had swelling and bruising of her left leg, with marked tenderness over the left knee. X-rays revealed a fracture of the left tibial plateau. The document then discusses tibial plateau fractures, including their mechanisms of injury, classification systems like Schatzker classification, associated injuries, and treatment options like non-operative management with bracing or operative fixation depending on the fracture pattern and stability.

1. Interesting case
EXT.ธนภัทร PCM

2.  Case : ผู้ป่วยหญิง อายุ 50 ปี no U/D
 CC : mc ชนเสาล้ม 6 hr PTA
 Primary survey
 A : able to talk, spontaneous movement of neck
 B : normal and equal breath sound both lungs, RR 16/min
 C: BP140/90 PR 88
 D : E4V5M6, pupil 2 mm RTLBE
 E : LW at forehead, deformities Lt leg

3.  PI : 6 hr PTA ขับ MC ไปชนกับเสา ศีรษะกระแทกพื้น ไม่สลบ จําเหตุการณ์ได้ มีขาซ้ายผิด
รูป มีอาการเจ็บบริเวณเข่าซ้าย เข่าซ้ายบวมมาก มีจํ้าเลือดที่เข่าซ้าย ลงนํ้าหนักขาซ้ายไม่ได้ งอเข่า
ซ้ายไม่ได้ ไม่มีอาการชา
 PH : - no Underlying diseases
 - no history of trauma before
 - history of allergy to penicillin : angioedema +
urticarial

4. Physical examination
 GA : good conciousness
 Heart : Normal S1S2, no murmur
 Lungs : normal and equal breath sound both lungs
 Abdomen : soft, not tender, no guarding, no rebound tenderness
 Ext : swelling and ecchymosis Lt leg, swelling Lt knee, Lt leg deformities,
marked tender at Lt knee, dorsalis pedis pulse2+, posterior tibial pulse 2+,
sensory intact

5. Lt Leg AP

6. Lt leg Lateral

7. Dx ???

8. Dx
 Fracture Tibial plateau

10. Fracture of Tibial Plateau
 Mechanism of injuries : Varus/Valgus load with axial load (Most common:Valgus with
axial load)
 Related high energy trauma ( direct injury or fall from height) or low energy but have
osteoporosis
 Frequently associated with soft tissue injuries
 Associated injuries
 meniscus tear ( Lateral:associated with SchatzkerII > Medial:MC associated with Schatzker IV )
 ACL injury (MC in type V and VI)
 Vascular injury (type IV)
 Compartment syndrome

12. Schatzker classification

13. Fracture of Tibial Plateau
 Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau,
originally defined as having less than 4 mm of depression or displacement
 Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I
fracture with a depressed component
 Schatzker III: pure depression of the lateral tibial plateau
 divided into two subtypes
 Schatzker IIIa: with lateral depression
 Schatzker IIIb: with central depression
 Schatzker IV: medial tibial plateau fracture with a split or depressed component
 Schatzker V: wedge fracture of both lateral and medial tibial plateau
 Schatzker VI: transverse tibial metadiaphyseal fracture, along with any type of tibial
plateau fracture

14. Treatment
 1.Non-Operative
 Hinged knee brace, PWB for 8-12 wks
 Indication minimal displace or depressed fractures, low energy fracture stable
to varus/valgus alignment, nonambulatory patients
 2.Operative
 Severe open fracture
 Highly comminuted fracture
 Condylar widening >5mm
 Varus/valgus instability
 All bicondylar fracture