Tibial plateau fracture pathophysiology: Difference between revisions

Jump to navigation Jump to search
(Created page with "__NOTOC__ {{Tibial plateau fracture}} {{CMG}}; {{AE}} {{Rohan}} ==Overview== ==Pathophysiology== *The fracture pattern and severity of comminution depends on multiple...")
 
No edit summary
Line 8: Line 8:


==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   
Line 25: Line 25:
[[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]]]]
|}
|}
*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.  
Line 43: Line 43:


===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

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 pathophysiology 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 pathophysiology

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 pathophysiology

CDC on Tibial plateau fracture pathophysiology

Tibial plateau fracture pathophysiology in the news

Blogs on Tibial plateau fracture pathophysiology

Directions to Hospitals Treating Psoriasis

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]
    • Nature of the fall
    • Bone quality
    • Age of the patient
    • Weight of the patient
    • Energy involved
    • Position of the knee and leg at the time of impact
  • Decrease in bone mass density involves following process:[2]

Anatomy

Anatomy of tibial plateau.Source: Case courtesy of Henry Vandyke Carter [Public domain
]
  • 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

  1. Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
  2. 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.
  3. Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
  4. Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
  5. Ramponi DR, McSwigan T (2018). "Tibial Plateau Fractures". Adv Emerg Nurs J. 40 (3): 155–161. doi:10.1097/TME.0000000000000194. PMID 30059369.

Template:WH Template:WS