Leg/Knee Case 1 ED Management
Tibial Plateau fracture
Orthopedics should be consulted in the ED to determine if surgical intervention is indicated. An emergency department CT scan of the affected knee is commonly requested for surgical decisions, as it gives a better depiction of the degree of depression of the plateau. Alternatively, if rapid orthopedics follow up can be ensured, the patient can be placed in a knee immobilizer, made non-weight bearing, and follow up with orthopedics as an outpatient.
Surgical indications include:
- open fracture
- compartment syndrome
articular surface depression (the degree of which is controversial)
- axial malalignment
- >10 degrees ligamentous instability when the knee flexed to 20 degrees
Cases not meeting those criteria are nonoperative and are treated with an above-knee cast, orthopedic follow-up within 1 week, and non-weightbearing status for 8-12 weeks.