Knee
Tibial plateau fracture
Tibial plateau fractures are classified into six patterns that separate lower-energy lateral injuries from higher-energy medial, bicondylar and metaphyseal-diaphyseal injuries.
What you are actually deciding
A medial plateau fracture implies a high-energy varus mechanism and should be treated as a spontaneously reduced knee dislocation until vascular status is confirmed. CT is standard for planning and frequently changes the type assigned from radiographs.
Classification system1
Clinical decision rule2
- Ottawa Knee Rule5 itemsOttawa Knee RuleThe Ottawa Knee Rule determines whether an acute knee injury requires radiographs using five criteria — age 55 or over, isolated patellar tenderness, fibular head tenderness, inability to flex to 90 degrees, and inability to bear weight for four steps — and is close to 99% sensitive for clinically significant fractures.
- Pittsburgh Knee Rules3 itemsPittsburgh Knee RulesThe Pittsburgh Knee Rules indicate a knee radiograph after blunt trauma or a fall when the patient is younger than 12 or older than 50, or cannot walk four weight-bearing steps in the emergency department — and the rule does not apply at all to any other mechanism of injury.