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Tibial Plateau Fracture Dislocations

- See: 
       - Tibial Plateau Frx Menu, Rim fractures:
- Discussion:
    - frx dislocations of tibial plateau will have assoc:
          - knee dislocations, and ligamentous injuries;
          - meniscal injuries, which are usually not repairable;
          - N/V injuries, increasing from 2% for type I to 50% for type V, w/ an overall avg of 15%, approx that of classic knee dislocation;

- Radiographs:

- Type I - Coronal Split Fracture:
    - account for 37% of tibial plataue fracture dislocations;
    - frx involves medial plateau, is apparent on the lateral view, w/ frx line running at 45 deg to medial plateau in oblique coronal transverse plane;
    - frx may extend to lateral side, & may include avulsion frx of fibular styloid, avulsion of the cruciates, and Gerdy's tubercle are common;

- Treatment:
    - PreOp Planning
    - these frxs frequently require require closed reduction & percutaneous screw fixation to improve reduction & allow early ROM in cast brace;
    - if ORIF is required, fragment usually reduces in extension & can be fixed w/ interfragmentary screws;
    - assoc ligamentous injuries can be repaired along w/ capsular disruption;
    - protected wt bearing is continued for 8 to 10 weeks;

- Post Operative Care and Compications

 Operative strategy in postero-medial fracture-dislocation of the proximal tibia