Case conference

1
Case conference

• Present by R3 ???
• Direct by Dr.???

2
General information

• Name XXX
• Age 27 y/o
• Gender female
• BH 172 cm
• BW 82 kg
• PH s/p L4/L5 L5/S1 discetomy on 96/01
• Denied any systemic disease

3
Chief complaint

• Left knee pain after traffic accident at 960820

4
Present illness

• Traffic accident on 0960820 (Motorcycle vs
  automobile). Hemarthrosis()
• Persistent left knee pain for a month

5
0960820
6
0960820
7
0960913
8
Physical examination

• Left knee swelling()
• Tenderness around lateral tibial area.
• Click sound when flexion-extension movement.
• Neurologic deficit nil

9
CT
10
CT
11
CT
12
Impression

• Left tibial plateau fracture , Shatzkers type 3

13
Operation

• Arthroscopic assisted allograft bone grafting.
• Remove osteochondral fragment
• Fluoroscopic assisted reduction

14
Arthroscopic finding
15
Arthroscopic finding.
16
Arthroscopic finding
17
Post-operative
18
Discussion
19
Definition

• Tibial plateau fracture
• Low energy
• High energy

20
Classification
21
Soft tissue injury
Arthroscopy. 22(6)669-75, 2006 Jun.

• Incidence70/98(71)
• Meniscus tear(57)
• ACL(25)
• PCL(5)
• LCL(3)
• MCL(3)
• ACL injury is high association with type 4 and 6

22
Image study

• CT???
• MRI???

23
Operative indication CORR 1994 (302) 199-205

• Tibial plateau
• Articular incongruity of 3mm
• Condylar widening gt5 mm
• Lateral tilt or valgus malaligment
• Greater 10 or instability greater than 10 of the
  nearly extended knee compared to with
  contralateral side

24
Role of arthroscopy (Rockwood)

• Advantage
• Accurate assess articular surface
• Repair meniscus and cruciate ligament
• Cortical window elevation for type 2 and 3
• Disadvantage
• Fluid extravasation
• Compartment syndrome

25
(No Transcript)
26
Is Shatzkers classification enough??

• Posterior tibia injury
• Fibular head involvement.