Tibial plateau ORIF - Schatzker type III fracture

Case contributed by Amanda Er

Presentation

Slipped and fell, landing on left knee. Now has substantial pain and swelling, unable to weight bear at all. Tender on lateral aspect of knee joint with severely restricted range of motion. No open wounds.

Patient Data

Age: 60 years
Gender: Female

Initial presentation

X-ray

Displaced fracture of the lateral tibial plateau with lipohemarthrosis and surrounding soft tissue swelling.

Pre-operative planning

CT

Comminuted, displaced, intra-articular fracture of the proximal tibia. The predominant split, depressed fracture component involves the lateral tibial plateau. A transverse fracture component is also noted at the lateral tibial plateau which extends to the proximal tibiofibular articulation. Lateral displacement of the dominant fracture fragment. The fracture also involves the tibial spines and interspinous region, with an undisplaced transverse fracture line extending into the medial tibial plateau/articular surface.

Comminuted, displaced, intra-articular fracture of the proximal fibula with involvement of the proximal tibiofibular joint.

Tricompartmental osteoarthritic changes of the knee joint in the form of marginal osteophytes. Moderate suprapatellar bursal effusion.

Intraoperative imaging

Fluoroscopy

Intraoperative imaging performed for tibia plateau fracture - Schatzker type III.

Post-operative imaging

X-ray

Interval open reduction and internal fixation (ORIF) of a depressed comminuted fracture of the proximal left tibia. No periprosthetic loosening seen.

Case Discussion

Schatzker type III fractures of the tibial plateau are one of the more common types of tibial plateau fractures 1, denoting pure depression of the lateral tibial plateau. Of note were the patient's porotic bones resulting in a higher possibility of such an injury occurring.

Post-operative notes: 

  • K wires drilled into fragment for joystick technique

  • fracture reduced with bone clamps and held with K wires

  • compression plate positioned and held with K wires

  • sequential insertion of locking screws done

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