Mind the Gap and Smile

​A man came to the ED in the middle of the night saying he was jumped and struck on the knee with some object. He complained of severe pain, difficulty ambulating, and swelling. When the tech tried to get the standard series of four knee views, the patient said he couldn't do more than one, at least not without more pain meds. The tech, arms crossed, asked me what I wanted to do. "Do you want to give him more meds, and I'll try again?" he asked.​Popping the sole image up on the screen, I said, "I'll give him more pain meds because he almost certainly has a tibial plateau fracture. I'm going to send him for a CT." There were a few clues that made me sure that his lateral tibial plateau was broken.What first jumped out to me was the asymmetry of the distance between the femoral condyle and the tibial plateau. In fact, the lateral femoral condyle even overlapped the tibia. There was no gap. Arthritis can cause joint narrowing, but there were no other signs of that.Secondly, the sclerotic line of the lateral tibial articular surface was gone. I want both the medial and the lateral articular surface to be "smiling" at me. The concave white line from the tibial spine in the center to the edge of the articular surface was missing laterally. Closer inspection showed an irregularity of the cortex with concern for a cortical break. The irregularity is indicated by the red arrows in the image.​There was a slightly hypodense area inferior to the locati...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs