TIBIAL PLATEAU

Siti Nur Amira

C 11110875
Advisors
dr. Wira Sundoko
dr. Alfa Januar Krista
Supervisor

Orthopaedic and Traumatology Department

Hasanuddin University
2015

Patient Identity

Name
: MNA
Age
: 30 years old
Sex
: Male
Date of admittance : 19th April 2015
MR Number
: 708978

History Taking
Chief Complaint: Pain at the left knee.
History of illness : Patient suffered from the
knee pain since 2 day before admitted to the
Wahidin Sudirohusodo Hospital due to accident.
Mechanism of Trauma: The patient was riding
a motorcycle and suddenly felt to the left side
which his knee directly hitting the road and
cannot stand up well after the accident.
History of unconsciousness (-), nausea (-), vomit
(-).

Primary Survey
Airway : Patent
Breathing: RR=20x/min, symmetrical,
spontaneous, thoracoabdominal type
Circulation : BP=130/80 mmHg,
P=82x/minute regular and strong
Disability : GCS 15 (E4M6V5), light reflex
+/+, isochoric pupil 2.5/2.5 mm
Environment : Axillary temperature of
36.5oC

Secondary Survey
Left Knee joint
I
: Deformity (+), swelling (+), hematoma
(+), excoriated wound (+) at anterior
aspect of knee which same level as patella
P
: Tenderness (+), Patellar Tapping(+),
Ballotement sign (+)
ROM : Active and passive motions of knee joints
is limited due to pain
NVD : Sensibility is good, pulsation of dorsalis
pedis and tibialis posterior artery is
palpable, Capillary refill time < 2

Secondary Survey
Left Leg Region
I
: Deformity (+), swelling (+), hematoma (+)
P
: Tenderness (+)
ROM : Active and passive motions of knee joints is
limited due to pain
:Active and passive motions of ankle joints is
good
NVD : Sensibility is good, pulsation of dorsalis
pedis and tibialis posterior artery is palpable,
Capillary refill time < 2

LEG LENGTH DISCREPANCY

(LLD)
Leg

Right

Left

ALL

93 cm

80 cm

TLL

93 cm

80 cm

LLD

0 cm

Clinical Picture

Figure 1: Anterior and lateral view of left knee

Laboratory Findings
TEST
WBC

RESULT
11.6 x 103 /uL

RBC

5.29 x 106 /uL

HGB

16.0 g/dL

HCT

47 %

PLT

215 x 103 /uL

HbsAg

Negative

CT

800

BT

300

Radiology Findings

Figure 2: Knee X-ray at AP and lateral aspect shows fracture of tibial plateau

Radiology Findings

Figure 3: Tibia and fibula X-ray at AP and lateral view shows

fracture of tibial plateau

Diagnosis
Closed fracture of left tibia
plateau
Hemarthrosis left knee joint

Management

IVFD Ringer Lactat

Analgetic
Antibiotic
Apply long leg back slab at left lower
limb
Elevation of left lower limb
Plan for arthrocentisis
Plan for ORIF

Resume
A male, 30 years old suffered from the knee pain since 2 day
before admitted to the Wahidin Sudirohusodo Hospital due to
accident.
From physical finding there are swelling, deformity, hematoma,
excoriated wound at anterior aspect of knee which same level as
patella, tenderness, positive patellar tapping and Ballotement
sign at the left knee joint, active and passive motions of the
knee joints are limited due to pain and distal neurovascular
within normal range.
From physical finding there are swelling, deformity, hematoma
and tenderness at the left leg region, active and passive motions
of the knee joints are limited due to pain and distal
neurovascular within normal range.
From radiological findings at both knee and tibia x-rays, there is
fracture at tibial plateau.

DISCUSSION :
FRACTURE OF TIBIAS
SHAFT

Anatomy

Netter s concise orthopaedic anatomy, P.

288

Compartemen of Leg

Netters concise
orthopaedic anatomy, P. 316

Netters concise
orthopaedic anatomy, P. 317

Netters concise orthopaedic anatomy, P.

318

Netters concise
orthopaedic anatomy, P. 319

Mechanism of Trauma
BUMPER FRACTURE
Varus stress +
compression

Valgus stress +
compression

Medial plateau fracture

Lateral plateau fracture

Appleys . Sistem Of orthopaedis & fracture,8th edition.

Clinical sign
Pain

Swelling

Histor
y of
trau
ma
Hemato
ma

Tenderne
ss

Physical examination
Hemarthrosis
Bulge test
Ballotement test
Tapping test
Ligament involvement
Laschman test
Anterior drawer test

Classification
Schatzer Classification
AO Classification
Moore Classification

Treatment
Conservative

Closed reduction
Apply long leg cast
Pain medication if needed
Functional bracing with Early weight-bearing

Treatment
Non operative
Cast brace

Operative

Complications
-

Compartment syndrome
Stiffness
Infection
Malunion & Nonunion
Post-trauma ostearthritis
Peroneal nerve injury
Popliteal artery laceration
Avaskular necrosis