Musculoskeletal case studies for medical students

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History A 25 year old male was hit by a car. The fracture was closed but there was marked swelling over the proximal tibia. Neurovascular intact, no other injuries
Initial X ray
Description AP X ray
X ray
Description Lateral X ray
Problem The 25 year old male who suffered a pedestrian motor vehicle accident. How would you classify this injury and how would you manage it?
X ray after treatment
Description X ray after ORIF
Post management further view

There is an intraarticular fracture of the lateral side of the proximal left tibia. It is split and a depressed area can be seen. This can be classified as a (Schatzker type 2 injury.

Discussion of management

The fracture was immobilised in a back slab and admitted. A computer tomogramme was obtained and this confirmed an area of depression on the lateral tibial plateau. Ten days later an open reduction was done. The depressed area was elevated with a bone graft, and a buttress plate and screws were used to keep the fragments in position. The knee was mobilised postoperatively and the patient discharged on crutches.

Plateau fractures swell a lot and it is often better to delay treatment w week or so to allow swelling to subside. The majority of displaced fractures require open reduction. If you have to manage one at a small hospital, Immobilise with a backslab, elevate, and arrange to have the patient transferred to somewhere ORIF can be competently done.


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