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Radiographic Studies for Tibial Plateau Frx

- AP and Lateral:
     - radiographs are assessed for frx locations, displacement, alignment;
     - lateral plateau is convex from front to back & side to side, whereas medial one is concave;
              - lateral plateau is higher than medial one, which indicates amount of plateua depression;
     - upper tibial articular surface nl inclines posteriorly from 10-15 deg & hence by angling AP beam caudally 15 deg will give better views;
              - on standard x-ray of knee, plateau appears ellicptical in shape, & posterior edge is represented by lower of two lines;
     - consider radiographs of contra-lateral plateau for templating;
     - role of the fibula in plateau frx:
     - reference:
              - Segond fracture combined with tibial plateau fracture.

- Oblique: internal and external
     - helpful in determining the amount and location of depression;

- Stress View: to document ligamentous laxity;
     - according to Rasmussen, major indication for Rx is not measure of depression of fragment or articular surface but presence of varus or 
           valgus instability of 10 deg or more w/ knee flexed 20 deg;

- Traction Radiographs:
     - may be useful in more complex frx;

- Tomograms:
     - consider ordering both the AP and the Lateral Tomographic cuts;

- CT:
     - consider either 1.5 mm fine axial cuts w/ coronal reconstructions (for pts who cannot bend their knees, or 5 mm axial cuts along with 3
             mm direct coronals for patients who can bend their knees;
     - defines the size of the fracture
     - depression of the fragments
     - position of the lateral wedge and the remaining intact bone;
     - comminution of the fracture, particularly the depressed fragment;
     - case example:
            - at first glance, the AP radiograph does not show the lateral sided depression, but a closer look shows a subchondral density well below the joint line;
            - seeing that the radiograph can under-represent the amount of the depression, a CT scan should generally be obtained


     - references:
             Tibial plateau fractures: evaluation with MR imaging.
             Computerised axial tomography for tibial plateau fractures.






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