Presentation
Unspecified acute trauma to the right leg.
Patient Data
There is a simple non-displaced oblique fracture extending through the distal third of the tibial diaphysis, best appreciated on the lateral projection. There is no evidence of comminution. Additionally, there is subtle depression with a zone of subchondral impaction involving the medial tibial plateau.
The previously described fracture seen on the radiograph is further demonstrated with evidence of callus formation at the diaphyseal fracture. The tibial plateau fracture is better visualized on the CT and is localized to the posterior aspect of the medial surface. There is subchondral irregularity of the anteromedial aspect of the medial femoral condyle; which may represent superimposed osteoarthrosis versus subchondral injury sustained during the initial trauma.
Case Discussion
Tibial shaft fractures are often due to high energy mechanisms but do not always have obvious findings on radiograph. A dedicated search pattern of the osseous cortices reduces the possibility of missing the fracture, as well as ensuring no additional findings are missed.
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