Radiographic Studies for Tibial Plateau Frx

- AP and Lateral:
     - radiographs are assessed for frx locations, displacement, alignment;
     - lateral plateau is convex from front to back & side to side, whereas medial one is concave;
              - lateral plateau is higher than medial one, which indicates amount of plateua depression;
     - upper tibial articular surface nl inclines posteriorly from 10-15 deg & hence by angling AP beam caudally 15 deg will give better views;
              - on standard x-ray of knee, plateau appears ellicptical in shape, & posterior edge is represented by lower of two lines;
     - consider radiographs of contra-lateral plateau for templating;
     - role of the fibula in plateau frx:
     - reference:
              - Segond fracture combined with tibial plateau fracture.

- Oblique: internal and external
     - helpful in determining the amount and location of depression;

- Stress View: to document ligamentous laxity;
     - according to Rasmussen, major indication for Rx is not measure of depression of fragment or articular surface but presence of varus or 
           valgus instability of 10 deg or more w/ knee flexed 20 deg;

- Traction Radiographs:
     - may be useful in more complex frx;

- Tomograms:
     - consider ordering both the AP and the Lateral Tomographic cuts;

- CT:
     - consider either 1.5 mm fine axial cuts w/ coronal reconstructions (for pts who cannot bend their knees, or 5 mm axial cuts along with 3
             mm direct coronals for patients who can bend their knees;
     - defines the size of the fracture
     - depression of the fragments
     - position of the lateral wedge and the remaining intact bone;
     - comminution of the fracture, particularly the depressed fragment;
     - case example:
            - at first glance, the AP radiograph does not show the lateral sided depression, but a closer look shows a subchondral density well below the joint line;
            - seeing that the radiograph can under-represent the amount of the depression, a CT scan should generally be obtained


     - references:
             Tibial plateau fractures: evaluation with MR imaging.
             Computerised axial tomography for tibial plateau fractures.






Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, June 15, 2012 11:33 am