Tibial plateau fracture differential diagnosis: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Rohan Bhimani (talk | contribs)
nocaptcha, Widget editors
1,101 edits
No edit summary
Rohan Bhimani (talk | contribs)
nocaptcha, Widget editors
1,101 edits
No edit summary
Line 6: Line 6:
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 laxity|ligamentous]]  injury such as anterior cruciate ligament, posterior cruciate ligament, collateral ligaments and meniscal injury
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 laxity|ligamentous]]  injury such as anterior cruciate ligament, posterior cruciate ligament, collateral ligaments and meniscal injury


==Differentiating Distal Radius Fracture from other Diseases==
==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 laxity|ligamentous]]  injury such as anterior cruciate ligament, posterior cruciate ligament, collateral ligaments and 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>
* 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 laxity|ligamentous]]  injury such as anterior cruciate ligament, posterior cruciate ligament, collateral ligaments and 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>


Revision as of 18:49, 1 February 2019

Tibial plateau fracture Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tibial plateau fracture from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Tibial plateau fracture differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Tibial plateau fracture differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Tibial plateau fracture differential diagnosis

CDC on Tibial plateau fracture differential diagnosis

Tibial plateau fracture differential diagnosis in the news

Blogs on Tibial plateau fracture differential diagnosis

Directions to Hospitals Treating Psoriasis

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
Symptoms Physical examination
Imaging
Pain Restriction of Movements Deformity Tenderness Integrity of extensor mechanism Distal Pulses X-ray CT scan MRI
Tibial plateau fracture + + +/- + + +/-
  • Fracture fragment displacement
  • Fracture fragment angulation
  • Accurate diagnosis of fracture pattern ans aids in classification
  • Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.
 CT
Segond Fracture + + - + + +
  • Evidence of fracture on radiographs is usually seen
  • Evidence of fracture on CT scan is usually seen
  • Soft tissue swelling and tear of the anterior cruciate ligament (ACL) accompanying the fracture is seen
 MRI
  • It is pathgnomic of ACL tear
Patella Fracture + + + + - +
  • Fracture fragment displacement
  • Fracture fragment angulation
  • CT confirms the x-ray finding
  • Swelling and tear of the patellar tendon and the retinaculum may be seen
  • Also helps to identify osteochondral fragments
 X-ray
  • Inability to do straight leg raising test.
Tibial tuberosity avulsion fracture + + + + - +
  • Tuberosity avulsion and displacement is seen
  • CT confirms the x-ray finding
  • Helps to identify accompanying patellar tendon injury
 X-ray
  • Inability to do straight leg raising test.
Patella dislocation + + + + +/- +
  • Disclocated patella
  • Subluxated patella
  • Associated fractures
  • CT confirms x-ray findings
  • Identifies damage to medial patellofemoral ligament.
  • Identifies damage to retinacular ligament and orientation of the surrounding muscles
 MRI
  • Apprehension Test positive
Knee Dislocation + + + + +/- +/-
  • Type of knee dislocation
  • Associated fractures
  • CT confirms the x-ray findings and shows any osteochondral injury
  • MRI shows damage to internal structures such as muscles, ligaments and neurovascular bundle.
 MRI
  • Angiography of the lower limb is mandatory to check blood flow to the lower limb and decrease the chances of vascular insult
Diseases Pain Restriction of Movements Deformity Tenderness Integrity of extensor mechanism Distal Pulses X-ray CT scan MRI Gold standard Additional findings
Meniscus Injury + +/- - +/- + +
  • Normal
  • Normal
  • It helps identify the type of tear and classify the tear.
  • It also aids in management plan for meniscal injury.
 MRI
  • McMurray Test positive for meniscal injury
Ligament Injuries (ACL, PCL, MCL, LCL) + +/- - + + +
  • Usually Normal
  • It may show associated avulsion fracture
  • Normal
  • It helps to identify partial or complete tear
  • It also aids in distinguishing acute versus chronice tears
  • It may show signs of early degeneration and cartilage wear due to ligament injury
 MRI
  • Lachmann Test and Anterior Drawer Test positive in Anterior cruciate ligament tear (ACL)
  • Posterior drawer test and Dial test positive for posterior cruciate ligament (PCL)
  • Valgus stress test is positive for Medial Collateral Ligament (MCL)
  • Varus stress test is positive for Lateral Collateral Ligament (LCL)
Quadriceps Tendon Rupture + + + + - +
  • Usually Normal
  • It may show associated avulsion fracture
  • Normal
  • It shows degree of tear
  • It also aids in surgical planning
 MRI
  • Defect present superior to superior pole of patella
Osgood - Schlatter Disease + + - + + +
  • Fracture of tibial tuberosity apophysis is seen
  • CT confirms x-ray findings
  • Sweeling and effusion of the joint ma be seen
 X-ray
  • Adolescents are commonly affected by the disease.
Peripheral Vascular Injuries + - - + + -
  • Normal
  • Normal
  • Normal
 Doppler ultrasound
  • Doppler ultrasound and angiography of the lower limb confirms the disease
Maisonneuve fracture + + + + + +
  • Fracture fragment displacement
  • Fracture fragment angulation
 CT confirms x-ray findings X-ray
  • Foot drop may be present in few patients
  • Electromyography and Nerve conduction studies done to check for any damage to commom peroneal nerve

References

  1. ↑ 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.
  2. ↑ Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
  3. ↑ Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
  4. ↑ 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.
  5. ↑ 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.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Tibial_plateau_fracture_differential_diagnosis&oldid=1544831"