May 2021: 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