|
Year |
2005 |
|---|---|
|
Question Number |
113. |
|
Category |
Musculoskeletal Trauma |
Question
The injury shown in Figures 33a and 33b is most correctly classified as a
1- Schatzker type 4 plateau fracture.
2- Schatzker type 5 plateau fracture.
3- Schatzker type 6 plateau fracture.
4- proximal tibia total condylar fracture-dislocation.
5- proximal tibia rim avulsion fracture-dislocation.
Figures
Answer (click for answer)
The correct answer is 4.
Tibial plateau fractures are most commonly divided according to the Schatzker classification system. Schatzker I fractures are lateral plateau splits, Schatzker II fractures are lateral plateau split depressions, Schatzker III fractures are lateral plateau depressions, Schatzker IV fractures are medial plateau fractures, Schatzker V fractures are bicondylar fractures, and Schatzker VI fractures are plateau fractures with metaphyseal – diaphyseal dissociation. Proximal tibial fracture-dislocations are differentiated from tibial plateau fractures by ligamentous involvement in what would otherwise be considered only a fracture, the increased risk and potential for arterial injury, and the instability of the fracture pattern. The most commonly used classification system for these proximal tibial fracture– dislocations is that by Moore. Type 1 is a split fracture-dislocation, type 2 is an entire condyle fracture-dislocation, type 3 is an avulsion type fracture-dislocation, type 4 is a rim compression fracture, and type 5 is a 4-part fracture-dislocation with discontinuity of the tibial shaft and the condyles. Looking at the images given, this is a fracture-dislocation involving the total condyle (Moore type 2). It mimics a Schatzker IV, but the fracture line is lateral to the tibial eminence. This fracture is highly unstable and is the equivalent of tearing the ACL, PCL, and MCL. Both peroneal nerve and vascular injuries are seen frequently with this fracture pattern.
Reference: RECOMMENDED READINGS: Bennett WF, Browner B: Tibial plateau fractures: A study of associated soft tissue injuries. J Orthop Trauma 1994;8:183-188.
Kellam JF, Fischer TJ, Tornetta P III, et al (eds): Orthopaedic Knowledge Update: Trauma 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 167-175.
