Tibial plateau fracture pathophysiology: Difference between revisions
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(Created page with "__NOTOC__ {{Tibial plateau fracture}} {{CMG}}; {{AE}} {{Rohan}} ==Overview== ==Pathophysiology== *The fracture pattern and severity of comminution depends on multiple...") |
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==Pathophysiology== | ==Pathophysiology== | ||
*The fracture pattern and severity of [[comminution]] depends on multiple factors including: | *The fracture pattern and severity of [[comminution]] depends on multiple factors including:<ref>{{cite book | last = Azar | first = Frederick | title = Campbell's operative orthopaedics | publisher = Elsevier | location = Philadelphia, PA | year = 2017 | isbn = 9780323374620 }}</ref> | ||
**Nature of the fall | **Nature of the fall | ||
**[[Bone]] quality | **[[Bone]] quality | ||
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[[File:Gray257.png|300px|thumb|Anatomy of tibial plateau.[https://upload.wikimedia.org/wikipedia/commons/8/8b/Gray257.png Source: Case courtesy of Henry Vandyke Carter [Public domain]]]] | [[File:Gray257.png|300px|thumb|Anatomy of tibial plateau.[https://upload.wikimedia.org/wikipedia/commons/8/8b/Gray257.png Source: Case courtesy of Henry Vandyke Carter [Public domain]]]] | ||
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*Majority of the weight in the lower leg is transmitted through tibia. | *Majority of the weight in the lower leg is transmitted through tibia.<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> | ||
*The tibial plateau is the proximal portion of the tibia and forms the part of the knee joint. | *The tibial plateau is the proximal portion of the tibia and forms the part of the knee joint. | ||
*The stronger of the two articular surfaces is the medial tibial condyle whereas the lateral tibial condyle is a weaker portion of the joint. | *The stronger of the two articular surfaces is the medial tibial condyle whereas the lateral tibial condyle is a weaker portion of the joint. | ||
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===Mechanism of Fracture=== | ===Mechanism of Fracture=== | ||
*Proximal tibial injuries can occur due to direct trauma or indirect mechanisms such as axial compression. | *Proximal tibial injuries can occur due to direct trauma or indirect mechanisms such as axial compression.<ref name="pmid30059369">{{cite journal| author=Ramponi DR, McSwigan T| title=Tibial Plateau Fractures. | journal=Adv Emerg Nurs J | year= 2018 | volume= 40 | issue= 3 | pages= 155-161 | pmid=30059369 | doi=10.1097/TME.0000000000000194 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30059369 }} </ref> | ||
*The causes of most tibial plateau fractures are a valgus stress associated with an axial load. | *The causes of most tibial plateau fractures are a valgus stress associated with an axial load. | ||
*Most tibial plateau fractures result from motor vehicle-related injuries followed by sports-associated injuries. | *Most tibial plateau fractures result from motor vehicle-related injuries followed by sports-associated injuries. | ||
Revision as of 21:27, 31 January 2019
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Tibial plateau fracture Microchapters |
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Tibial plateau fracture pathophysiology On the Web |
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Risk calculators and risk factors for Tibial plateau fracture pathophysiology |
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
Pathophysiology
- The fracture pattern and severity of comminution depends on multiple factors including:[1]
- Decrease in bone mass density involves following process:[2]
- Autophagy is the mechanism through which osteocytes evade oxidative stress.
- The capability of autophagy in cells decreases as they age, a major factor of aging.
- As osteocytes grow, viability of cells decrease thereby decreasing the bone mass density.
Anatomy
 |
- Majority of the weight in the lower leg is transmitted through tibia.[3][4]
- The tibial plateau is the proximal portion of the tibia and forms the part of the knee joint.
- The stronger of the two articular surfaces is the medial tibial condyle whereas the lateral tibial condyle is a weaker portion of the joint.
- The medial from the lateral tibial condyle are separated by the intercondylar eminence which serves as the attachment for the anterior cruciate ligament (ACL).
Medial Condyle
- The medial condyle is larger than the lateral condyle.
- The articular surface of medial condyle is oval and it is long axis is anteroposterior.
- The central part of the medial condylar surface is slightly concave.
- The peripheral part is falt and seperated from femoral condyle by the medial meniscus.
Lateral Condyle
- The lateral condyle overhangs the shaft of tibia.
- The articular surface is nearly circular.
- The central part is slightly concave and comes in direct contact with femoral condyle.
- The peripheral part is flat and seperated from femur by the lateral meniscus.
Mechanism of Fracture
- Proximal tibial injuries can occur due to direct trauma or indirect mechanisms such as axial compression.[5]
- The causes of most tibial plateau fractures are a valgus stress associated with an axial load.
- Most tibial plateau fractures result from motor vehicle-related injuries followed by sports-associated injuries.
- The bumper of a car striking the lateral plateau during this vehicle–pedestrian-related injury causes a valgus mechanism of injury.
- Motor vehicle injuries are high energy and often result in splitting types of fractures as well as direct injury to the surrounding soft tissues.
- Low-energy forces can cause a tibial plateau fracture usually in older patients with poor bone quality due to rotational forces.
- Such injuries are primarily seen in women >50 years with osteoporosis resulting in a depressed pattern plateau fracture.
References
- ↑ Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
- ↑ Onal M, Piemontese M, Xiong J, Wang Y, Han L, Ye S; et al. (2013). "Suppression of autophagy in osteocytes mimics skeletal aging". J Biol Chem. 288 (24): 17432–40. doi:10.1074/jbc.M112.444190. PMC 3682543. PMID 23645674.
- ↑ 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.
- ↑ Ramponi DR, McSwigan T (2018). "Tibial Plateau Fractures". Adv Emerg Nurs J. 40 (3): 155–161. doi:10.1097/TME.0000000000000194. PMID 30059369.