Supracondylar Tibial Plateau & Patellar Fractures

Supracondylar, Tibial Plateau, & Patellar Fractures

Dr. Wahby Ghalib CABMS, FJMC, MRCS

Supracondylar femoral #

Last 10 – 15 cm of femur

Classification

Extraarticlar Intraarticular unicondylar Intraarticular bicondylar


XR
# may be T- or Y-shaped # may be in the coronal plane (Hoffa #)


# may tilt posterior by gastrocnemius  compression of popliteal vessels & tibial nerve


Rx

Nonoperative Rx

In undisplaced or slightly displaced extraarticular #Skeletal traction  cast

Operative Rx

ORIF


Cx
Deformity : genu valgum or varum OA

Tibial plateau #

Mechanism
Varus force Valgus force Axial load

Classification (Schatzker)

1 : vertical split of lateral condyle 2 : vertical split + depression of lateral condyle 3 : depression of lateral condyle 4 : medial condyle # 5 : bicondylar # 6: condylar + subcondylar #



Lateral condyle # more common than medial Type 1 : occurs in young Type 3 : occurs in elderly Type 3 : is the commonest

Associating injuries

Menisci Ligaments Nerve

Rx

Type 1

Undisplaced : cast or f. brace 3 m PWB after 1 m FWB after 2 m Displaced : ORIF

Type 2

Depression < 5mm  nonoperativeDepression > 5mm  ORIF + BG

Type 3

As 2

Type 4

As 1 & 2

Type 5 & 6

Usually displaced & need ORIF


Cx
Vascular injury Compartment s. Specially 5 & 6 Nerve injury : common peroneal Deformity Joint stiffness OA

Patellar #

Patella
Biggest sesamoid bone in the body Improves the lever of the quadriceps The quadriceps inserts to the tibia via the patellar tendon & extensor retinacula

Mechanism

Direct : e.g. dashboard Indirect : forceful contraction

Types

Undisplaced crack Stellate ( comminuted) # Displaced transverse #


DDx
Bipartite patella : usually superolateral & bilateral


Rx

Undisplaced crack

Extensor mechanism is intact Back slab 4w Early quadriceps exercises

Stellate (comminuted) #

Extensor mechanism is intact Risk of OA Back slab & early exercises Patellectomy may be needed

Displaced transverse #

Extensor mechanism is disrupted ORIF + repair of extensor retinacula

Objectives :

Understanding the importance of knee injuries being of high incidence and significant morbidity. Developing basic skills to diagnose injuries around the knee and providing the early supportive measures. Building up basic skills to identify and deal with complications specific to this area.

Objectives :

Stressing the importance of rehabilitation programs in the management. Clarification of the different treatment options and their indications and drawbacks.