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TIBIAL PLATEAU

Siti Nur Amira
C 11110875
Advisors
dr. Wira Sundoko
dr. Alfa Januar Krista
Supervisor

Orthopaedic and Traumatology Department
Hasanuddin University
2015

Patient Identity




Name
: MNA
Age
: 30 years old
Sex
: Male
Date of admittance : 19th April 2015
MR Number
: 708978

• Mechanism of Trauma: The patient was riding a motorcycle and suddenly felt to the left side which his knee directly hitting the road and cannot stand up well after the accident. • History of illness : Patient suffered from the knee pain since 2 day before admitted to the Wahidin Sudirohusodo Hospital due to accident. .History Taking • Chief Complaint: Pain at the left knee. • History of unconsciousness (-). nausea (-). vomit (-).

symmetrical. thoracoabdominal type • Circulation : BP=130/80 mmHg.5 mm • Environment : Axillary temperature of 36. spontaneous. isochoric pupil ϕ 2.Primary Survey • Airway : Patent • Breathing: RR=20x/min. light reflex +/+. P=82x/minute regular and strong • Disability : GCS 15 (E4M6V5).5oC .5/2.

excoriated wound (+) at anterior aspect of knee which same level as patella P : Tenderness (+). Patellar Tapping(+). pulsation of dorsalis pedis and tibialis posterior artery is palpable.Secondary Survey Left Knee joint I : Deformity (+). swelling (+). hematoma (+). Ballotement sign (+) ROM : Active and passive motions of knee joints is limited due to pain NVD : Sensibility is good. Capillary refill time < 2” .

pulsation of dorsalis pedis and tibialis posterior artery is palpable. hematoma (+) P : Tenderness (+) ROM : Active and passive motions of knee joints is limited due to pain :Active and passive motions of ankle joints is good NVD : Sensibility is good. Capillary refill time < 2” .Secondary Survey Left Leg Region I : Deformity (+). swelling (+).

LEG LENGTH DISCREPANCY (LLD) Leg  Right Left ALL 93 cm 80 cm TLL 93 cm 80 cm LLD 0 cm .

Clinical Picture • Figure 1: Anterior and lateral view of left knee .

6 x 103 /uL RBC 5.29 x 106 /uL HGB 16.Laboratory Findings TEST WBC RESULT 11.0 g/dL HCT 47 % PLT 215 x 103 /uL HbsAg Negative CT 8’00” BT 3’00” .

Radiology Findings Figure 2: Knee X-ray at AP and lateral aspect shows fracture of tibial plateau .

Radiology Findings Figure 3: Tibia and fibula X-ray at AP and lateral view shows fracture of tibial plateau .

Diagnosis • Closed fracture of left tibia plateau • Hemarthrosis left knee joint .

Management • • • • IVFD Ringer Lactat Analgetic Antibiotic Apply long leg back slab at left lower limb • Elevation of left lower limb • Plan for arthrocentisis • Plan for ORIF .

• From radiological findings at both knee and tibia x-rays.Resume • A male. hematoma. hematoma and tenderness at the left leg region. active and passive motions of the knee joints are limited due to pain and distal neurovascular within normal range. deformity. deformity. positive patellar tapping and Ballotement sign at the left knee joint. active and passive motions of the knee joints are limited due to pain and distal neurovascular within normal range. 30 years old suffered from the knee pain since 2 day before admitted to the Wahidin Sudirohusodo Hospital due to accident. there is fracture at tibial plateau. • From physical finding there are swelling. excoriated wound at anterior aspect of knee which same level as patella. • From physical finding there are swelling. tenderness. .

DISCUSSION : FRACTURE OF TIBIA’S SHAFT .

Anatomy Netter ’s concise orthopaedic anatomy. 288 . P.

Compartemen of Leg .

P. 316 .Netter’s concise orthopaedic anatomy.

317 .Netter’s concise orthopaedic anatomy. P.

318 .Netter’s concise orthopaedic anatomy. P.

Netter’s concise orthopaedic anatomy. 319 . P.

. Sistem Of orthopaedis & fracture.8th edition.Mechanism of Trauma • BUMPER FRACTURE Varus stress + compression Valgus stress + compression Medial plateau fracture Lateral plateau fracture Appley’s .

Clinical sign Pain Swelling Histor y of trau ma Hemato ma Tenderne ss .

Physical examination Hemarthrosis • Bulge test • Ballotement test • Tapping test Ligament involvement • Laschman test • Anterior drawer test • … .

Classification • Schatzer Classification • AO Classification • Moore Classification .

Treatment • Conservative • • • • Closed reduction Apply long leg cast Pain medication if needed Functional bracing with Early weight-bearing .

Treatment • Non operative • Cast brace • Operative .

Complications - Compartment syndrome Stiffness Infection Malunion & Nonunion Post-trauma ostearthritis Peroneal nerve injury Popliteal artery laceration Avaskular necrosis .