I see AP views of rt Knee X ray and CT shows a depressed fracture of lateral tibial condyle. I would like to know the mechanism of injury and age of patient
In high velocity injury I will approach the patient using ATLS protocol. After ruling out life threatening injuries, I will ensure that the injury is closed isolated and the limb is neurovascularly intact and will assess the soft tissue injury for dee abrasions, crushing and compartment syndrome
I would like to see the lateral view.I will give adequate analgesia and give a back slab if there is no significant soft tissue injury, compartment syndrome or NV injury
I want to see the Reconstruction view of tibia ct to assess the fracture pattern, articular surface and occult fracture lines not visible in the xray
Significant articular step off and widening of proximal tibia suggests that operative treatment is warranted and I will discuss this with the patient
Operative treatment require preoperative assessment of
Soft tissue envelope
NV status
Fracture pattern
State of the ligaments
Operative treatment
Principle is to restore the articular surface with step off <3mm and widening <5mm and align and stabilise the fracture to the mechanical axis so as to allow early ROM exercises
Reduction can be achieved by direct or indirect means and fixed by percut/open means. My preferred method of reduction for this fracture is by opening a window distally and reducing the fracture by indirect means and fill the gap with BG substitute and fix with raft screws
The fixation is protected by buttress plating and assess the state of ligaments and fixation using fluoroscopy and arthroscopy