Interesting case EXT.ธนภทัร PCM

Case : ผู้ ป่วยหญิง อาย ุ50 ปี no U/D CC : mc ชนเสาล้ม 6 hr PTA

Primary survey A : able to talk, spontaneous movement of neck B : normal and equal breath sound both lungs, RR 16/min C: BP140/90 PR 88 D : E4V5M6, pupil 2 mm RTLBE E : LW at forehead, deformities Lt leg

PI : 6 hr PTA ขบั MC ไปชนกบัเสา ศีรษะกระแทกพืน้ ไมส่ลบ จําเหตกุารณ์ได้ มีขาซ้ายผิดรูป มีอาการเจ็บบริเวณเขา่ซ้าย เข่าซ้ายบวมมาก มีจํา้เลอืดท่ีเข่าซ้าย ลงนํา้หนกัขาซ้ายไมไ่ด้ งอเข่า

ซ้ายไมไ่ด้ ไมมี่อาการชา

PH : - no Underlying diseases - no history of trauma before - history of allergy to penicillin : angioedema +

urticarial

Physical examination

GA : good conciousness

Heart : Normal S1S2, no murmur

Lungs : normal and equal breath sound both lungs

Abdomen : soft, not tender, no guarding, no rebound tenderness

Ext : swelling and ecchymosis Lt leg, swelling Lt knee, Lt leg deformities, marked tender at Lt knee, dorsalis pedis pulse2+, posterior tibial pulse 2+, sensory intact

Lt Leg AP

Lt leg Lateral

Dx ???

Dx

Fracture Tibial plateau

Fracture of Tibial Plateau

Mechanism of injuries : Varus/Valgus load with axial load (Most common:Valgus with axial load)

Related high energy trauma ( direct injury or fall from height) or low energy but have osteoporosis

Frequently associated with soft tissue injuries

Associated injuries meniscus tear ( Lateral:associated with SchatzkerII > Medial:MC associated with Schatzker IV )

ACL injury (MC in type V and VI)

Vascular injury (type IV)

Compartment syndrome

Schatzker classification

Fracture of Tibial Plateau

Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement

Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component

Schatzker III: pure depression of the lateral tibial plateau

divided into two subtypes

Schatzker IIIa: with lateral depression

Schatzker IIIb: with central depression

Schatzker IV: medial tibial plateau fracture with a split or depressed component

Schatzker V: wedge fracture of both lateral and medial tibial plateau

Schatzker VI: transverse tibial metadiaphyseal fracture, along with any type of tibialplateau fracture

Treatment

1.Non-Operative Hinged knee brace, PWB for 8-12 wks

Indication minimal displace or depressed fractures, low energy fracture stable to varus/valgus alignment, nonambulatory patients

2.Operative Severe open fracture

Highly comminuted fracture

Condylar widening >5mm

Varus/valgus instability

All bicondylar fracture