Tibial plateau fracture differential diagnosis: Difference between revisions
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Created page with " __NOTOC__ {{Tibial plateau fracture}} {{CMG}}; {{AE}} {{Rohan}} ==Overview== Tibial plateau fracture must be differentiated from wrist strain, Ligamentous laxity|ligam..." |
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__NOTOC__ | |||
{{Tibial plateau fracture}} | {{Tibial plateau fracture}} | ||
{{CMG}}; {{AE}} {{Rohan}} | {{CMG}}; {{AE}} {{Rohan}} | ||
==Overview== | ==Overview== | ||
Tibial plateau fracture must be differentiated from [[ | Tibial plateau fracture must be differentiated from other causes of acute [[knee]] pain, [[restriction of movements]], and [[deformity]] such as [[patella fracture]], [[Patella|patella dislocation]], [[knee dislocation]], [[Ligamentous laxity|ligamentous]] injury such as [[anterior cruciate ligament]], [[posterior cruciate ligament]], [[collateral]] ligaments and [[Tear of meniscus|meniscal]] injury | ||
==Differentiating Tibial Plateau Fracture from other Diseases== | |||
* Tibial plateau fracture must be differentiated from other causes of acute [[knee]] pain, [[restriction of movements]], and [[deformity]] such as [[patella fracture]], [[Dislocated patella|patella dislocation]], [[knee dislocation]], [[Ligamentous laxity|ligamentous]] injury such as [[anterior cruciate ligament]], [[posterior cruciate ligament]], [[collateral]] ligaments and [[Tear of meniscus|meniscal injury]].<ref name="pmid24994048">{{cite journal| author=Karrasch C, Gallo RA| title=The acutely injured knee. | journal=Med Clin North Am | year= 2014 | volume= 98 | issue= 4 | pages= 719-36, xi | pmid=24994048 | doi=10.1016/j.mcna.2014.03.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24994048 }} </ref><ref>{{cite book | last = Rockwood | first = Charles | title = Rockwood and Green's fractures in adults | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia, PA | year = 2010 | isbn = 9781605476773 }}</ref><ref>{{cite book | last = Azar | first = Frederick | title = Campbell's operative orthopaedics | publisher = Elsevier | location = Philadelphia, PA | year = 2017 | isbn = 9780323374620 }}</ref><ref name="pmid7605307">{{cite journal| author=Arnold MH| title=Fractures of the tibial plateau in the elderly as a cause of immobility. | journal=Aust N Z J Med | year= 1995 | volume= 25 | issue= 2 | pages= 178 | pmid=7605307 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7605307 }} </ref><ref name="pmid28131634">{{cite journal| author=Aurich M, Koenig V, Hofmann G| title=Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review. | journal=Asian J Surg | year= 2018 | volume= 41 | issue= 2 | pages= 99-105 | pmid=28131634 | doi=10.1016/j.asjsur.2016.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28131634 }} </ref> | |||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Deformity | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Deformity | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness | ||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Integrity of extensor mechanism | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Distal Pulses | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan | ||
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | ||
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | ||
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* | * [[Fracture]] fragment displacement | ||
* | * [[Fracture]] fragment angulation | ||
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* Accurate diagnosis of [[Fracture|fractur]]<nowiki/>e pattern ans aids in [[classification]]. | |||
* Useful for preoperative surgical planning for patients with complex, multifragmentary fractures. | * Useful for preoperative surgical planning for patients with complex, multifragmentary fractures. | ||
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* Useful in diagnosing occult [[Bone fracture|fractures]], [[Ligamentous laxity|ligamentous]] and [[soft tissue]] injuries | * Useful in diagnosing occult [[Bone fracture|fractures]], [[Ligamentous laxity|ligamentous]] and [[soft tissue]] injuries | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |[[CT]] | ||
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|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Segond [[Fracture]] | ||
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* Evidence of [[Bone fracture|fracture]] on [[Radiograph|radiographs]] is usually seen | |||
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* Evidence of [[Bone fracture|fracture]] on [[CT]] scan is usually seen. | |||
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* [[Soft tissue]] swelling and tear of the [[anterior cruciate ligament]] (ACL) accompanying the [[fracture]] is seen | |||
| style="background: #F5F5F5; padding: 5px;" |[[MRI scan|MRI]] | |||
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* It is pathgnomic of [[Anterior cruciate ligament|ACL]] tear | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Patella fracture|Patella Fracture]] | |||
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
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* | * [[Fracture]] fragment displacement | ||
* [[Fracture]] fragment angulation | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * [[CT]] confirms the [[x-ray]] finding. | ||
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* [[ | * [[Swelling]] and [[tear]] of the [[patellar tendon]] and the [[retinaculum]] may be seen | ||
| style="background: #F5F5F5; padding: 5px;" | | * Also helps to identify osteochondral fragments | ||
| style="background: #F5F5F5; padding: 5px;" |[[X-ray]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Inability to do [[Straight leg raise|straight leg raising]] test. | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tuberosity of the tibia|Tibial tuberosity]] [[avulsion fracture]] | ||
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* | * [[Tubercle (anatomy)|Tuberosity avulsion]] and displacement is seen | ||
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* | * [[CT]] confirms the [[x-ray]] finding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Helps to identify accompanying [[Patellar tendon rupture|patellar tendon injury]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |[[X-ray]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Inability to do [[Straight leg raise|straight leg raising]] test. | ||
* | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Dislocated patella|Patellar dislocation]] | |||
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | |||
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* [[Dislocated patella|Disclocated patella]] | |||
* [[Subluxation|Subluxated]] [[patella]] | |||
* Associated [[fractures]] | |||
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* [[CT]] confirms [[x-ray]] findings | |||
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* Identifies damage to medial patellofemoral ligament. | |||
* Identifies damage to retinacular ligament and orientation of the surrounding muscles | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]] | |||
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* Apprehension Test positive | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Knee dislocation|Knee Dislocation]] | |||
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | |||
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* Type of [[knee dislocation]] | |||
* Associated [[fractures]] | |||
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* [[CT]] confirms the [[x-ray]] findings and shows any osteochondral injury | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | | |||
* [[MRI]] shows damage to internal structures such as [[muscles]], [[ligaments]] and [[Neurovascular bundle|neurovascular]] bundle. | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]] | |||
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* [[Angiography]] of the [[lower limb]] is mandatory to check [[blood flow]] to the [[lower limb]] and decrease the chances of [[Vascular injury|vascular insult]] | |||
|- | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain | |||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Restriction of Movements | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Deformity | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness | |||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Integrity of extensor mechanism | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Distal Pulses | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI | |||
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meniscus injuries|Meniscus Injury]] | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | |||
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* Normal | |||
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* Normal | |||
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* It helps identify the type of tear and classify the [[tear]]. | |||
* It also aids in management plan for [[Tear of meniscus|meniscal injury]]. | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI scan|MRI]] | |||
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* [[McMurray's test|McMurray's est]] positive for [[Tear of meniscus|meniscal injury]] | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[ | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ligament]] Injuries ([[ACL]], [[PCL]], [[MCL]], [[Lateral collateral ligament|LCL]]) | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
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* Usually Normal | |||
* It may show associated avulsion [[Bone fracture|fracture]] | |||
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* Normal | |||
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* It helps to identify partial or complete [[tear]] | |||
* It also aids in distinguishing acute versus chronic [[tears]] | |||
* It may show signs of early [[degeneration]] and [[Cartilage injuries|cartilage wear]] due to [[ligament]] injury | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]] | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | | |||
* [[Lachman test]] and [[Drawer test|Anterior Drawer test]] positive in [[Anterior cruciate ligament injury|Anterior cruciate ligament tear]] (ACL) | |||
* [[Posterior drawer test]] and Dial test positive for [[posterior cruciate ligament]] (PCL) | |||
* [[Valgus]] stress test is positive for [[MCL|Medial Collateral Ligament]] (MCL) | |||
* [[Varus]] stress test is positive for [[Lateral collateral ligament|Lateral Collateral Ligament]] (LCL) | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Quadriceps tendon rupture|Quadriceps Tendon Rupture]] | |||
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | |||
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* Usually Normal | |||
* It may show associated avulsion [[fracture]] | |||
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* Normal | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | | |||
* It shows degree of [[tear]] | |||
* It also aids in [[Surgery|surgical]] planning | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]] | |||
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* Defect present superior to superior pole of [[patella]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Osgood-Schlatter disease|Osgood - Schlatter Disease]] | |||
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* [[Bone fracture|Fracture]] of [[Tuberosity of the tibia|tibial tuberosity]] apophysis is seen | |||
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* [[CT]] confirms [[x-ray]] findings | |||
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* [[Swelling]] and effusion of the [[Joint (anatomy)|joint]] may be seen | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[X-ray]] | |||
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* [[Adolescent|Adolescents]] are commonly affected by the disease. | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Peripheral Vascular Injuries]] | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | | | style="background: #F5F5F5; padding: 5px; text-align: center;" | | ||
* | * Normal | ||
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* | * Normal | ||
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* | * Normal | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Doppler ultrasound]] | ||
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* | * [[Doppler ultrasound]] and [[angiography]] of the [[lower limb]] confirms the [[disease]] | ||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Maisonneuve fracture|Maisonneuve Fracture]] | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
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* [[Bone fracture|Fracture]] fragment displacement | |||
* [[Bone fracture|Fracture]] fragment angulation | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[CT]] confirms [[x-ray]] findings | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | | |||
* Useful in diagnosing occult [[Bone fracture|fractures]], [[Ligamentous laxity|ligamentous]] and [[soft tissue]] injuries | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[X-ray]] | |||
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* [[Foot drop]] may be present in few patients | |||
* [[Electromyography]] and [[Nerve conduction study|Nerve conduction studies]] done to check for any damage to [[Common fibular nerve|commom peroneal nerve]] | |||
|} | |} | ||
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[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Orthopedic surgery]] | [[Category:Orthopedic surgery]] | ||
[[Category:Fractures]] | [[Category:Fractures]] | ||
[[Category:Bone fractures]] | [[Category:Bone fractures]] |
Latest revision as of 00:25, 30 July 2020
Tibial plateau fracture Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Tibial plateau fracture differential diagnosis On the Web |
American Roentgen Ray Society Images of Tibial plateau fracture differential diagnosis |
Risk calculators and risk factors for Tibial plateau fracture differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]
Overview
Tibial plateau fracture must be differentiated from other causes of acute knee pain, restriction of movements, and deformity such as patella fracture, patella dislocation, knee dislocation, ligamentous injury such as anterior cruciate ligament, posterior cruciate ligament, collateral ligaments and meniscal injury
Differentiating Tibial Plateau Fracture from other Diseases
- Tibial plateau fracture must be differentiated from other causes of acute knee pain, restriction of movements, and deformity such as patella fracture, patella dislocation, knee dislocation, ligamentous injury such as anterior cruciate ligament, posterior cruciate ligament, collateral ligaments and meniscal injury.[1][2][3][4][5]
Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | |||||||
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Symptoms | Physical examination | ||||||||||
Imaging | |||||||||||
Pain | Restriction of Movements | Deformity | Tenderness | Integrity of extensor mechanism | Distal Pulses | X-ray | CT scan | MRI | |||
Tibial plateau fracture | + | + | +/- | + | + | +/- |
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CT | ||
Segond Fracture | + | + | - | + | + | + |
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MRI |
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Patella Fracture | + | + | + | + | - | + |
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X-ray |
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Tibial tuberosity avulsion fracture | + | + | + | + | - | + |
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X-ray |
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Patellar dislocation | + | + | + | + | +/- | + |
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MRI |
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Knee Dislocation | + | + | + | + | +/- | +/- |
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MRI |
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Diseases | Pain | Restriction of Movements | Deformity | Tenderness | Integrity of extensor mechanism | Distal Pulses | X-ray | CT scan | MRI | Gold standard | Additional findings |
Meniscus Injury | + | +/- | - | +/- | + | + |
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MRI |
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Ligament Injuries (ACL, PCL, MCL, LCL) | + | +/- | - | + | + | + |
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MRI |
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Quadriceps Tendon Rupture | + | + | + | + | - | + |
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MRI |
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Osgood - Schlatter Disease | + | + | - | + | + | + |
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X-ray |
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Peripheral Vascular Injuries | + | - | - | + | + | - |
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Doppler ultrasound |
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Maisonneuve Fracture | + | + | + | + | + | + | CT confirms x-ray findings |
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X-ray |
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References
- ↑ Karrasch C, Gallo RA (2014). "The acutely injured knee". Med Clin North Am. 98 (4): 719–36, xi. doi:10.1016/j.mcna.2014.03.002. PMID 24994048.
- ↑ Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
- ↑ Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
- ↑ Arnold MH (1995). "Fractures of the tibial plateau in the elderly as a cause of immobility". Aust N Z J Med. 25 (2): 178. PMID 7605307.
- ↑ Aurich M, Koenig V, Hofmann G (2018). "Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review". Asian J Surg. 41 (2): 99–105. doi:10.1016/j.asjsur.2016.11.011. PMID 28131634.