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Split Fractures

- Discussion: Tibial Plateau Frx Menu
    - in most split frxs, large articular frag has separated in coronal plane from posterior portion of medial tibial plateau;
    - fragment rarely separates from lateral plateau or from anterior aspect of either plateau;
    - 22% of these frxs will also have assoc intercondylar eminence frx;
    - 21% will have a cruciate or collateral ligament injury;

- Radiographs:
    - key feature on AP view is appearance of 2 level plateau on the same side of knee as the split fracture;
    - lateral x-rays show the size and displacement of the split fragment;
         - lateral x-ray made in full extension may demonstrate reduction of fragment to a normal articular level;
         - when knee is flexed, reduction is lost as femoral condyle subluxates with the split fragment;

- Non Operative Rx:
    - if frag reduces in full extension, either long leg cast is applied, or percutaneous pin fixation can be performed;
    - w/ closed treatment, by extending knee fully, closed reduction often succeeds in bringing articular fragment to normal articualr level;
    - keeping knee in extension usually prevents Loss of Reduction;

- Operative Treatment:
    - PreOp Planning
    - operative treatment is indicated for irreducible split fractures & those associated with intercondylar eminence fractures;
    - if frag reduces in full extension consider need for percutaneous pin fixation;
    - if fragment is displcaced > 2 mm, a large Steinmann pin can be inserted into frag to manually elevate it;
          - once fragment is elevated, pin is driven in further for temporary fixation;
          - cancellous screws are inserted from anterior to posterior, engagingsplit fragment;
    - frxs involving posteromedial aspect of tibia are approached posterior to medial collateral ligament & and the joint is entered distal to the medial meniscus

- Post Operative Care and Complications

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