Tibial plateau fracture
Introduction
Introduction to tibial plateau fracture The fracture of the tibial plateau (fractureoftibialplateau) is one of the most common fractures in the knee joint. The knee joint suffers from internal and external violent impact, or compression violence caused by falling can cause humeral condyle fracture, which is typical due to tibial plateau fracture. Intra-articular fractures, their treatment and prognosis will have a great impact on knee function. At the same time, tibial plateau fractures are often accompanied by articular cartilage, knee ligament or meniscus injury. Missed diagnosis and improper treatment may cause knee deformity, force line or stability problems, leading to joint function disorders. Therefore, the diagnosis and treatment of tibial plateau fractures is an important issue in knee trauma surgery. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: Traumatic arthritis
Cause
Causes of tibial plateau fracture
Indirect violence (30%):
When the height falls, the foot first hits the ground and then falls to the side. The force is transmitted by the foot along the humerus. The acceleration of the fall causes the weight of the body to be transmitted downward, which acts on the knee and twists due to the side falling. Force, resulting in collapse of the medial or lateral tibia.
Direct violence (30%):
When the violence directly hits the medial or external measurement of the knee, the knee joint is everted or inverted, resulting in fracture of the lateral or medial platform (mostly comminuted fracture, displacement of the fracture) or ligament injury.
Pathogenesis:
The tibial plateau fracture is the result of a strong varus or valgus stress combined with an axial load. During the injury, the femoral condyle exerts shear and compressive stress on the underlying tibial plateau, which can lead to a split fracture, a collapse fracture, or both. Coexistence, in fact, simple cleft palate fractures only occur in young people with dense bones. Only this joint surface can withstand compression. With the increase of age, the tight bones of the proximal humerus become sparse. It is only subjected to compressive stress, and when there is an axial compressive load, collapse or splitting collapse occurs.
Some scholars believe that the collateral ligament on one side is intact, which is an indispensable condition for the formation of the contralateral platform fracture. The effect of the medial collateral ligament is similar when the valgus stress is transmitted from the lateral femoral condyle to the lateral tibia. Hinge; the collateral ligament is similar to the hinge when the varus stress is transmitted from the medial malleolus to the medial platform. However, with the increase in the application of MRI, the incidence of ligament injury in patients with tibial plateau fracture is found. It is higher than previously thought. The size of violence not only determines the degree of fracture crushing, but also determines the degree of fracture displacement. In addition, it often combines soft tissue injury, such as lateral platform fracture often combined with MCL or ACL, injury, and medial platform fracture often combined with LCL. Or cruciate ligament or common peroneal nerve, vascular injury, and split fracture are caused by shear stress, which should be differentiated from marginal avulsion fracture and compression fracture. The latter often combined with knee fracture and dislocation, resulting in severe instability.
Prevention
Prevention of tibial plateau fracture
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease. Especially for special people such as workers on the construction site who are prone to injury, it is necessary to strengthen safety propaganda, enhance prevention awareness, avoid damage, and prevent fractures. In addition, for children and the elderly who are vulnerable to trauma, it is necessary to strengthen protection to prevent the occurrence of fractures caused by injury.
Complication
Complications of tibial plateau fractures Complications, traumatic arthritis
Malformation healing
Because the tibial plateau is mainly composed of cancellous bone, surrounded by soft tissue, has good blood supply and osteogenic ability, the fracture is easy to heal, but due to premature weight bearing, the collapse of the internal or external iliac crest; the internal fixation is not reliable, There is a defect in the comminuted fracture. If the bone is not fully implanted, the deformity will be healed. When the knee is varus>5°, the valgus is >15°, and the patient is walking with pain. Immediately correct the operation, such as 3cm under the tibial tuberosity for inverted V-shaped osteotomy. .
2. Posttraumatic arthritis
The incidence of traumatic arthritis after the platform fracture is still not very clear, but many scholars have confirmed that the joint surface is not smooth and joint instability can lead to post-traumatic arthritis, degenerative arthritis after young and old fractures, not The ideal indication for total knee arthroplasty. If arthritis is confined to the medial or lateral compartment, osteotomy can be used to correct it. In the case of severe arthritis in two or three compartments, joint fusion or artificial joint replacement is required. At the time of deciding whether to undergo surgery, age, knee range of motion and whether there is infection or not play an important role.
3. Knee joint stiffness
Knee joint limitation after fracture of the platform is common. This refractory complication is caused by damage to the knee extension device, damage to the articular surface caused by the original trauma, and soft tissue exposure for internal fixation. Braking further deteriorates the above factors. Generally, the braking time exceeds 3 to 4 weeks, which often causes a certain degree of permanent joint stiffness.
Symptom
Symptoms of tibial plateau fractures Common symptoms Joint swelling, tension, humeral pain
Knee joint swelling and pain after injury, activity disorder, due to intra-articular fractures, intra-articular hemorrhage, should pay attention to the history of injury, is valgus or varus injury, pay attention to check for collateral ligament injury, joint stability check Often suffering from pain, muscle tension, especially in the case of smash fractures, in the case of a single iliac fracture, the collateral ligament injury is on the opposite side, the tender point of the collateral ligament, that is, the site of its injury, in the fracture The lateral stability test was positive, and the clear lateral X-ray of the knee showed fractures, especially for non-displaced fractures.
Hohl made a simple classification according to 805 cases: no displacement fracture and displaced fracture, the former accounted for 24%, the latter was divided into local depression, the central depression and split fracture accounted for 26%, the total compression 11%, Split 3% and crush 10%.
Schatzker divided the tibial plateau fracture into 6 types.
Type I: simple wedge fracture or split fracture of the lateral platform.
Type II: cleft palate compression fracture of the lateral platform.
Type III: simple compression fracture of the lateral platform.
Type IV: medial platform fracture, which may be cleft palate or cleft palate compression.
Type V: a double ankle fracture including a split of the medial platform and the lateral platform.
Type VI: There are joint fractures and metaphyseal fractures at the same time. The humerus is separated from the diaphysis. The so-called diaphysis-dry metaphysis separation usually results in severe joint destruction, comminution, compression and sacral displacement.
Generally, there is no difficulty. The key is to understand the disease, especially when young doctors have insufficient experience in X-ray film. It is easy to ignore the existing fracture line or platform compression on the X-ray film.
Those with ligament injury should be carefully examined. If necessary, the colleagues in the operation should investigate and judge. The concomitant rate accounts for about 5% (more than 10% in hospitals with more sports injuries) and attention to the presence or absence of radial artery and common peroneal nerve. Accompanied by injuries.
For those who are unclear, CT scans may also be performed; if the individual suspects have ligament injury, MRI may also be used as appropriate.
Examine
Examination of the tibial plateau fracture
X-ray examination: routinely photographing the lateral lateral position of the knee, which can show the fracture and type. If the diagnosis is unclear, CT or MRI can be performed.
CT scan and three-dimensional reconstruction: scan the soft tissue and meniscus around the fracture and fracture.
MRI: Patients with suspected ligament injury may choose MRI as appropriate.
Diagnosis
Diagnosis and diagnosis of tibial plateau fracture
Generally, there is no difficulty. The key is to understand the disease, especially when the young doctor has insufficient experience in X-ray film. It is easy to ignore the existing fracture line or platform compression on the X-ray film.
1, with ligament injury, check carefully, if necessary, the colleague in the operation to explore and determine, the companion rate accounted for about 5% (can be more than 10% in hospitals with more sports injuries) and pay attention to the presence or absence of radial artery, Total nerves are accompanied by injuries.
2, for those who are unclear, CT scan can also be performed; if the individual suspects have ligament injury, MRI can also be used as appropriate.
3. This disease is generally not confused with other diseases.
