2.  45 YOM pedestrian struck
by a vehicle backing rapidly
out of the parking lot.
Patient was hit on the
lateral side of his right
knee by the car’s bumper
and immediately fell on the
ground spinning towards
the left and screaming in
pain. No LOC. Unable to
bear weight. Denies
numbness or tingling to his
lower extremities.
 T 97.9 P 117 BP 134/76 RR 18 O2 97%





on RA
Gen: Uncomfortable and in distress
2/2 pain, GCS 15.
Pulm: BS equal and CTA bilaterally.
Trachea midline.
CV: S1S2 tachycardia, pulses equal
throughout.
Pelvic: stable
RLE: Contusion/abrasion noted on
the lateral aspect of knee,
generalized swelling/effusion,
extensor/flexion preserved with
difficulty 2/2 pain, 20° instability
upon Valgus, anterior/posterior
drawers intact. Distal neurovascular
intact

4.  Lateral Tibial
Plateau Fracture
with medial
collateral ligament
injury.
 Note the depressed
articular surface.

5.  ABC’s of trauma resuscitation
 Pain management.
 Open fractures: Type and Screen, IV fluids, antibiotics
and copious irrigation. Update Tetanus. Emergent
Orthopedic consult.
 Nondisplaced/stable fractures: Immobilization/LongLeg posterior splint/RICE/Orthopedic referral within
one week. Strict non-weight bearing
 Displaced/unstable fractures: treat as non-displaced
PLUS Emergent Orthopedic consult.

6.  Oblique views helpful in detecting subtle tibial





plateau fractures.
CT of the knee crucial to determine the degree of
the articular surface irregularity.
ACL and MCL injury associated with lateral
plateau fractures.
PCL and LCL injury associated with medial plateau
fractures.
Stability defined as <10° of movement upon Valgus
and Varus at any point from full extension to 90°
flexion.
Operative management can be delayed without
significant consequences for up to 24-48 hours.

7.  Medial Tibial
Plateau Fracture.
 Is there a fracture?

8. 
Normal Radiograph. Criteria: No more than 5
mm of the tibial condyle should remain laterally
to the line drawn from lateral femoral condyle to
medial cortex of the fibular shaft.

Yes there is! Suspect subtle tibial plateau fracture in
this radiograph that doesn’t meet the normal criteria.
Arrow head shoes fracture.

9.  Axial CT showing lateral
tibial plateau fracture.
 3-D reconstruction of the CT images
on the left.

10.  Robert R. Simon, Steven J. Koenigsknecht, "Chapter 15.
Knee" (Chapter).
 http://www.imageinterpretation.co.uk/knee.html
 Tintinalli's Emergency Medicine:
A Comprehensive Study Guide, 7e . Chapter 271: Knee
Injuries.