Schatzker Type IV: Medial fracture of the tibial plateau with a split or depression often associated with damage to soft tissue, which can occur in both osteoporosis and traumatic injury cases.Depression in the lateral tibial plateau without a wedge or other fracture, most often in people with osteoporosis. Schatzker Type II: Split, wedge-shaped fracture combined with a deeper depression in the bone, often in people with osteoporosis or low bone quality.Schatzker Type I: A wedge-shaped fracture with minimal depression that often occurs in younger people.It is a system that describes the location and severity of a tibial plateau fracture. A protocol to perform bedside ultrasound as part of the first evaluation of extremity trauma may help us define the population for which further imaging is unnecessary and improve ED resource utilization.Doctors often use the Schatzker classifications system in North America. This approach may be particularly useful in resource-poor areas, and limit the patient’s exposure to radiation. 4 This improved sensitivity may limit the need for CT, prevent delayed diagnosis, and improve the patient’s length of stay. The sensitivity for finding an occult fractures is 84% with plain radiographs, and 94% when combined with POCUS. Incorporating POCUS into the evaluation of acute traumatic knee pain increases the likelihood of discovering an occult fracture. This finding is more specific for intra-articular fractures than serous joint effusions alone. Lipohemarthrosis is layering of fat and blood, which is indicative of an intra-articular fracture involving the bone medulla. 2 This may can lead to articular cartilage injury and long-term problems with mobility.īedside ultrasound may reveal lipohemarthrosis, suggesting a radiographically occult and subtle tibial plateau fracture. Approximately 15% of intra-articular fractures are radiographically occult, which may delay the diagnosis. Tibial plateau fractures can present with subtle radiographic findings. In this case, the attending physician recommended POCUS to evaluate for possible effusion or ligamentous injury given the patient’s persistent pain, inability to bear weight, and negative plain films (Figure 1). Ultrasound can be used in traumatic musculoskeletal injury to look for: 1 Be familiar with the ultrasound findings pathognomonic for a tibial plateau fracture.Understand the technique for performing an ultrasound evaluation of the knee in the setting of trauma.Is there a role for point-of-care ultrasound (POCUS) in this situation?
#Occult tibial plateau fracture portable#
Portable 2-view radiographs were obtained and interpreted as “no acute fracture.” On repeat examination, however, the patient continued to have pain and was now unable to bear weight on the affected extremity. She was tender to palpation over the proximal tibia.
#Occult tibial plateau fracture skin#
The emergency physician noted moderate swelling on exam with intact skin and distal pulses. She experienced no head strike or loss of consciousness, however she was unable to ambulate at the scene, and upon arrival to the ED, complained of left knee pain. A 70-year-old female with no past medical history was hit by a motor vehicle while crossing the street.
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