The Elusive Tibial Plateau Fracture

​"Can you check this guy's knee? He was hit by a car," the APP said, adding that she hadn't seen anything on the x-ray.The patient winced when I touched the area around the fibular head. Images flashed in my mind from 30 years ago when I missed a lateral tibial plateau fracture. The patient walked on it, displacing an undisplaced fracture, and he required surgery. I hadn't forgotten about him decades later.This patient's AP film looked fine: no break in the cortex. The trabecular pattern looked normal, but it was just one view.The oblique raised a tiny question—or was I just imagining things? Was there really a faint break of the cortex at the lateral tibial plateau? Would a CT tell us for sure?I knew this would increase the length of stay. It would probably be a mark against me, but it felt like the right thing to do, especially in COVID-19 times. It would be much easier to make the definitive diagnosis from the emergency department.​There it was, just as expected. He had an undisplaced lateral tibial plateau fracture. We wanted to keep it that way. I emphasized to the patient that he should not bear weight until the orthopedist said he could. He went home with a knee immobilizer, crutches, and a follow-up appointment.Tip to Remember: Undisplaced tibial plateau fractures can be subtle and difficult to see. Get a CT if you're unsure.Tags: Fibular head, tibial plateau, fracturePublished: 4/30/2021 8:51:00 AM
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs